Involving traditional health practitioners in HIV/AIDS interventions: Lessons from the Western Cape Province.

Despite international recognition of the potential value of collaboration between traditional health practitioners and western medicine, examples of this approach in South Africa are rare. Contextualised within the aims and objectives of the HIV/AIDS and STIs National Strategic Plan 2007-2011(NSP), the paper looks at one initiative, based in the Western Cape Province. It presents evidence of the scheme’s success to date, its potential for assisting in the NSP’s goals, and the possibility of further developments, which might enhance HIV/AIDS prevention and care strategies. Finally, the paper explores some key problems, and makes recommendations for future initiatives based on the experience

Children Under Pressure

Cada vegada els pares pressionen més els fills per por davant un futur que es presenta amb poques possibilitats. La formació, la cultura, segueix semblant una garantia d’èxit. L’estimulació cognitiva ha de començar tan aviat com sigui possible. L’educació ha de ser adquirida al més aviat possible. Cal ensenyar ben aviat calma, ordre i disciplina —principis del món dels adults— perquè després puguin ser competitius. No importa allò que sóc, sinó allò que tinc. La Pràctica Psicomotriu Aucouturier, representada per les escoles de l’ASEFOP (Associació Europea d’Escoles de Formació en Pràctica Psicomotriu), s’oposa a aquesta evolució social: l’objectiu dels nostres esforços no és l’estimulació cognitiva, sinó la maduració psicològica del nen com a resultat d’un desenvolupament personal harmònic. Encara que a Alemanya l’educació preventiva està molt endarrere en relació amb altres països d’Europa, ZAPPA (Zentrum für Aus- und Fortbildung in Psychomotorischer Praxis Aucouturier – Centre de formació i educació en pràctica psicomotriu Aucouturier), escola membre de l’ASEFOP, promou iniciatives d’educació preventiva que mostren com pot ser el futur.Cada día los padres presionan más a sus hijos por temor a un futuro que se presenta con pocas posibilidades. La formación, la cultura, sigue pareciendo una garantía de éxito. La estimulación cognitiva tiene que comenzar cuanto antes. La educación debe ser adquirida tan pronto como sea posible. Hay que enseñar, rápidamente, calma, orden y disciplina —principios del mundo de los adultos— para que después puedan ser competitivos. No importa lo que soy sino lo que tengo. La Práctica Psicomotriz Aucouturier, representada por las escuelas de la ASEFOP (Asociación Europea de Escuelas de Formación en Práctica Psicomotriz), se opone a esta evolución social: el objetivo de nuestros esfuerzos no es la estimulación cognitiva, sino la maduración psicológica del niño, como resultado de un desarrollo personal armónico. Aunque en Alemania la educación preventiva está muy atrasada en comparación con otros países de Europa, ZAPPA (Zentrum für Aus- und Fortbildung in Psychomotorischer Praxis Aucouturier –Centro de formación y educación en práctica psicomotriz Aucouturier), escuela miembro de la ASEFOP, promueve iniciativas de educación preventiva que muestran cómo puede ser el futuro.Every day parents are putting more pressure on their children because of their own fear of a future with little chance. Training, culture, is still a guarantee of success. Cognitive stimulation must begin as soon as possible. Education must be obtained the sooner the better. We must teach quickly, calm, order and discipline —principles of grownups world— so they can then be competitive. It doesn’t matter who I am but what I have. The Psychomotor Practice of Aucouturier, represented by the ASEFOP schools, opposes this social evolution: the aim of our efforts is not cognitive stimulation, but the psychological maturity of the child, as a result of a harmonious personal development. Although preventive education is way behind compared with other European countries in Germany, ZAPPA, school member of the ASEFOP, promotes preventive education initiatives that show how future might be

Saltmarsh as habitat of Common Redshanks Tringa totanus breeding in the Wadden Sea of Lower Saxony, Germany : useful hideaway or ecological trap?

Die Brutbestände des Rotschenkels nehmen in weiten Teilen Europas stark ab, während die des Wattenmeeres stabil sind bzw. lange Zeit waren. Verschiedene Studien legen jedoch nahe, dass die Reproduktion des Rotschenkels im Wattenmeer räumlich stark variiert. Ziel der in den Jahren 2004 bis 2006 durchgeführten telemetrischen Untersuchungen von Küken des Rotschenkels auf der Insel Wangerooge und im Petersgroden am Festland war, erstmalig den Bruterfolg dieser Art zu beziffern, die bisher vorläufige Einschätzung einer räumlich stark variierenden Reproduktion zu verifizieren sowie Modelle künftiger Bestandsverläufe zu entwerfen. Aufgrund geringerer Gelege-Prädation erzielten die Vögel auf Wangerooge einen sehr viel höheren Schlupferfolg (2005/06: 64 bzw. 93 % der Gelege) als im Petersgroden (2004 bis 2006: 4 bis 15 %). Abgesehen von witterungsbedingten Totalverlusten im Jahre 2004 am Festland, lag die Mortalität nicht-flügger Küken in beiden Gebieten bei 70-80 %. Der Bruterfolg in den Jahren 2005 und 2006 wird auf 0,51 bzw. 1,0 Küken pro Brutpaar auf Wangerooge und auf konstant 0,15 Küken/Brutpaar am Festland geschätzt. Bei bisherigen Schätzungen (Literaturwerte) jährlicher Mortalitätsraten von 35 (Subadulte) bzw. 25 % (Adulte) wären diese Bruterfolge bei Weitem nicht ausreichend, um den untersuchten Festlandsbestand langfristig zu erhalten. Auf Wangerooge dagegen würden zumindest zeitweise mehr Jungvögel produziert als für die Erhaltung des regionalen Bestandes notwendig sind. Die bisherige Annahme einer räumlich variierenden Reproduktion von Rotschenkeln im Wattenmeer konnte mit diesen Ergebnissen bestätigt werden. Ob die gefundenen Bruterfolge zur Erklärung der gegenwärtigen Bestandsdynamik des Rotschenkels im Wattenmeer ausreichen, bleibt allerdings weiterhin fraglich. Die Notwendigkeit eines integrierten Populationsmonitorings wird vor diesem Hintergrund diskutiert. Die nicht-flüggen Küken waren in beiden Untersuchungsgebieten sehr ortstreu. Sie entfernten sich in den ersten Lebenswochen durchschnittlich maximal knapp 200 m vom ursprünglichen Neststandort und nutzten dabei eine Fläche von durchschnittlich etwa 0,4 ha. Die Raumnutzung von Rotschenkel-Familien legt nahe, dass der Bruterfolg der Vögel auch nach dem Schlupf der Küken noch potentiell stark durch die landwirtschaftliche Nutzung gefährdet ist, insbesondere durch Mahd. Die hier vorgelegte Untersuchung unterstreicht die Vermutung, dass landwirtschaftliche Nutzung ein ungeeignetes Mittel des Habitatmanagements für Brutvögel der Salzrasen darstellt.In contrast to most other European breeding sites, the breeding population of the Redshank Tringa totanus in the European Wadden Sea is stable in most areas of the ecosystem. As suggested by recent studies on hatching success, however, Redshank reproduction is spatially variable and cannot reliably explain the population trend mentioned above. From 2004 to 2006, a telemetry study on Redshank chicks was conducted in Petersgroden (mainland) and on the island of Wangerooge to record annual breeding success and its spatial variability and to derive predictions on future population trends. Due to lower predation, birds on Wangerooge achieved considerably higher hatching success than birds at the mainland (2005/06: 64 and 93 % of clutches vs. 4 to 15 %, 2004-2005). Apart from total losses due to weather conditions in 2004 at the mainland, chick mortality was relatively constant between regions and years (70-80 %). Derived from chick mortality, breeding success was 0.51 (2005) and 1.0 (2006) chicks per pair on Wangerooge and constantly 0.15 chicks per pair at the mainland. Considering published estimates of annual subadult (35 %) and adult (25 %) mortality, breeding success achieved during this study should not be sufficient to maintain the regional population of the mainland study site. In contrast, the Wangerooge population produced more chicks than needed to sustain its local population. The assumption of spatially varying reproduction of Redshanks breeding in the Wadden Sea could be confirmed by this study. However, it still has to be clarified whether Redshank population dynamics is explained by this varying breeding success. Due to a lack of knowledge in annual survival rates, the necessity of initiating an integrated population monitoring project is discussed. As additionally revealed by chick telemetry, non-fledged chicks were found up to only about 200 m from its former nest site and used about 0.4 ha of the respective saltmarsh habitat. Small home range sizes of Redshank broods within the saltmarsh suggest a potential vulnerability to agricultural habitat management, especially to mowing. Derived from these results, it is unlikely that agriculture is an appropriate way of managing saltmarsh for breeding birds

Absence of Erythrocyte Sequestration and Lack of Multicopy Gene Family Expression in Plasmodium falciparum from a Splenectomized Malaria Patient

BACKGROUND:To avoid spleen-dependent killing mechanisms parasite-infected erythrocytes (IE) of Plasmodium falciparum malaria patients have the capacity to bind to endothelial receptors. This binding also known as sequestration, is mediated by parasite proteins, which are targeted to the erythrocyte surface. Candidate proteins are those encoded by P. falciparum multicopy gene families, such as var, rif, stevor or PfMC-2TM. However, a direct in vivo proof of IE sequestration and expression of multicopy gene families is still lacking. Here, we report on the analysis of IE from a black African immigrant, who received the diagnosis of a malignant lymphoproliferative disorder and subsequently underwent splenectomy. Three weeks after surgery, the patient experienced clinical falciparum malaria with high parasitemia and circulating developmental parasite stages usually sequestered to the vascular endothelium such as late trophozoites, schizonts or immature gametocytes. METHODOLOGY/PRINCIPAL FINDINGS:Initially, when isolated from the patient, the infected erythrocytes were incapable to bind to various endothelial receptors in vitro. Moreover, the parasites failed to express the multicopy gene families var, A-type rif and stevor but expression of B-type rif and PfMC-2TM genes were detected. In the course of in vitro cultivation, the parasites started to express all investigated multicopy gene families and concomitantly developed the ability to adhere to endothelial receptors such as CD36 and ICAM-1, respectively. CONCLUSION/SIGNIFICANCE:This case strongly supports the hypothesis that parasite surface proteins such as PfEMP1, A-type RIFIN or STEVOR are involved in interactions of infected erythrocytes with endothelial receptors mediating sequestration of mature asexual and immature sexual stages of P. falciparum. In contrast, multicopy gene families coding for B-type RIFIN and PfMC-2TM proteins may not be involved in sequestration, as these genes were transcribed in infected but not sequestered erythrocytes

Not-So-Risky Business? Assessing the Risk of Integrating Large RPVs into the Current Air Traffic System

In spite of considerable efforts to commercialize large remotely piloted vehicles (RPV), an integration of these RPVs into the existing Air Transportation System (ATS) and Airspace Structure is pending. The purpose of this paper was to assess the risks of an exemplary integration of a Heron 1 type RPV into the existing European air space structure within the current regulatory framework and without the availability of sense and avoid technology. Six incident occurrence scenarios were investigated, based on a modified Fault Tree Analysis and Eurocontrol’s risk matrix. It was found that without the implementation of technological or procedural changes, an integration of a Heron 1 RPV presents a low to medium risk to air traffic. Recommended risk mitigation measures include equipping the RPV-operator with a recognized air picture, equipping the RPV with TCAS, installing a conventional telephone land line between the RPV-operator and air traffic control, and commencing the integration of large RPVs into air traffic at night. Further, simulation and flight based research is necessary to demonstrate whether these control measures would reduce the risk to an overall low level

3OD – Once-daily (OD) TDF-containing HAART in HIV-1-infected former IVDU-patients receiving opiate substitution : efficacy, tolerability and adherence

Purpose of the study: There is a clinical need for antiretroviral therapy (ART) regimens that simplify dosing and make adherence easier for specific patient groups such as former intravenous drug users (IVDU) receiving opiate substitution. Availability of tenofovir DF (TDF) and other once-daily (OD) agents could offer a viable OD regimen. The 3OD study was designed to evaluate the use of OD HAART in IVDU patients. Methods: 3OD was a single-arm, multicentre, 48-weeks trial to assess efficacy, tolerability and adherence to a OD TDF-containing HAART regimen in former IVDU patients receiving opiate substitution. Of 67 patients enrolled, 27 were antiretroviral treatment naïve, 10 were virologically suppressed (<400 copies/mL), and 30 were re-starting HAART without prior virological failure. Opiate substitution was adjusted according to subject symptoms of opiate overdosing or withdrawal. Various methods were used to assess adherence: besides pill count, patients were asked to fill in a MASRI (Medication Adherence Self-Report Inventory) questionnaire and an electronic log pad diary. Calculation of adherence by pill count assumed that unreturned pills had been taken by the subjects. Summary of results: Overall, 55% (n = 37, ITT, M = F) of patients had viral load 100% using pill count. MASRI showed adherence rates of 80–100% in 83–85% of patients; however, 15 patients never entered any data. Diary data were entered by 57 patients; diary data were entered for fewer days than patients received treatment (mean difference 113 days, calculated from treatment start and stop dates). Conclusion: TDF in combination with other OD antiretrovirals in former IVDU patients showed comparable efficacy to that seen in the average HIV-1 infected population. However, measurement of adherence to self-administered HAART via pill count, MASRI or diary may be misleading in this population

Noninferiority of cetuximab every-2-weeks versus standard once-weekly administration schedule for the first-line treatment of RAS wild-type metastatic colorectal cancer

Abstract Aim This study assessed whether cetuximab 500 mg/m2 administered every 2 weeks (Q2W), when combined with chemotherapy as a first-line (1L) treatment, was noninferior to the approved dose (400 mg/m2 followed by 250 mg/m2 once weekly [Q1W]) for overall survival (OS) in adults with RAS wild-type metastatic colorectal cancer (mCRC). Methods This pooled analysis included patients receiving 1L treatment with cetuximab Q1W or Q2W in combination with chemotherapy from post-authorisation studies with patient-level data available to the sponsor. Baseline characteristics were adjusted with a propensity score using inverse probability of treatment weighting (IPTW). Noninferiority in terms of OS was tested with a noninferiority margin for the hazard ratio (HR) of 1.25 using a Cox proportional hazards regression model. Secondary outcomes were progression-free survival (PFS), overall response rate (ORR) and rates of lung/liver metastases resection and serious adverse events. Results OS time was noninferior in the Q2W cohort (n = 554) compared to the Q1W cohort (n = 763), with a HR after IPTW (95% confidence interval) of 0.827 (0.715–0.956) and median OS times of 24.7 (Q1W) and 27.9 (Q2W) months. There were no major differences in PFS (HR: 0.915 [0.804–1.042]). The odds ratios (ORs) after IPTW for ORR (1.292 [1.031–1.617]) and the rates of lung/liver metastases resection (1.419 [1.043–1.932]) favoured the Q2W regimen. No differences were noted in the occurrence rate of any SAE between groups; the OR after IPTW was 1.089 (0.858–1.382). Conclusions The cetuximab Q2W regimen was noninferior to the Q1W regimen for OS in the 1L treatment of mCRC

S1-Guideline Cutaneous Angiosarcomas - Update 2021

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Janus—a comprehensive tool investigating the two faces of transcription

Motivation: Protocols to generate strand-specific transcriptomes with next-generation sequencing platforms have been used by the scientific community roughly since 2008. Strand-specific reads allow for detection of antisense events and a higher resolution of expression profiles enabling extension of current transcript annotations. However, applications making use of this strandedness information are still scarce. Results: Here we present a tool (Janus), which focuses on the identification of transcriptional active regions in antisense orientation to known and novel transcribed elements of the genome. Janus can compare the antisense events of multiple samples and assigns scores to identify mutual expression of either transcript in a sense/antisense pair, which could hint to regulatory mechanisms. Janus is able to make use of single-nucleotide variant (SNV) and methylation data, if available, and reports the sense to antisense ratio of regions in the vicinity of the identified genetic and epigenetic variation. Janus interrogates positions of heterozygous SNVs to identify strand-specific allelic imbalance. Availability: Janus is written in C/C++ and freely available at http://www.ikmb.uni-kiel.de/janus/janus.html under terms of GNU General Public License, for both, Linux and Windows 64×. Although the binaries will work without additional downloads, the software depends on bamtools (https://github.com/pezmaster31/bamtools) for compilation. A detailed tutorial section is included in the first section of the supplemental material and included as brief readme.txt in the tutorial archive. Contact: [email protected] or [email protected] Supplementary information: Supplementary data are available at Bioinformatics onlin