Management of HIV-associated cryptococcal disease in South Africa

In routine-care settings, the 10-week mortality associated with cryptococcal meningitis (CM) is high, even with prompt, appropriate antifungal treatment and correctly timed initiation of antiretroviral therapy (ART). While early diagnosis of HIV infection and initiation of ART prior to the development of AIDS is the most important way to reduce the incidence of CM, a cryptococcal antigenaemiascreen-and-treat intervention has the potential to reduce mortality by identifying patients prior to onset of CM. Antifungal treatment for HIV-associated CM is divided into three phases over a minimum period of 1 year: (i) a 2-week induction phase, including intravenous amphotericin B deoxycholate as a backbone; (ii) an 8-week consolidation phase with fluconazole 400 mg daily; and (iii) a maintenance phase with fluconazole 200 mg daily. Amphotericin B should be paired with another antifungal agent to maximise cerebrospinal fluid fungal clearance. World Health Organization guidelines emphasise that patients receiving amphotericin B-containing regimens should have access to a ‘minimum package of toxicity prevention, monitoring and management to minimise the serious amphotericin B-related toxicities particularly hypokalaemia and nephrotoxicity’. Raised intracranial pressure is a serious and often fatal complication of CM, which requires good pressure management with repeat lumbar punctures. ART should be initiated 4 - 6 weeks after starting antifungal therapy. In many cases, relapse CM among South African patients occurs because of suboptimal adherence to secondary prophylaxis with fluconazoleand/or the antifungal not being prescribed

South African surgical registrar perceptions of the research project component of training: Hope for the future?

Background. The Health Professions Council of South Africa requires that a research project be submitted and passed before registration as a specialist.Objective. To describe surgical registrars’ perceptions of the compulsory research project.Method. Ethics clearance was received before commencing the study. A questionnaire was developed to collect feedback from surgical registrars throughout South Africa (SA). Completed questionnaires underwent descriptive analysis using MS Excel. Fisher’s exact test and the χ2 test were used to compare perceptions of the research-experienced and research-naive groups.Results. All medical schools in SA were sampled, and 51.5% (124/241) of surgical registrars completed the questionnaire. Challenges facing registrars included insufficient time (109/124), inadequate training in the research process (40/124), inadequate supervision (31/124), inadequate financial resources (25/124) and lack of research continuity (11/124). Of the registrars sampled, 67.7% (84/124) believed research to be a valuable component of training. An overwhelming percentage (93.5%, 116/124) proposed a dedicated research block of time as a potential solution to overcoming the challenges encountered. Further proposals included attending a course in research methodology (79/124), supervision by a faculty member with an MMed or higher postgraduate degree (73/124), and greater research exposure as an undergraduate (56/124). No statistically significant differences were found between the perceptions of the researchexperienced and research-naive groups.Conclusions. Challenges facing surgical registrars in their efforts to complete their research projects were identified and solutions to these problems proposed. It is heartening that respondents have suggested solutions to the problems they encounter, and view research as an important component of their careers

Life within chronic care: is this a service or sentence?

Background: Understanding the meaning of one’s lived experiences improves one’s understanding of what it means to be human, in association with the social, cultural and historical context in which being a human occurs. The authors in this study describe the lived experiences of residents within a chronic care facility including the practitioner and family perspectives.Methods: A qualitative approach was employed with a single-site, descriptive, instrumental case study design. Purposive sampling was utilised to select the chronic facility. Multiple sources of evidence included narratives, semi-structured interviews with staff, residents and family members, and activity profiles of the residents augmented by an ergonomic evaluation of the facility. Content analysis using within-case analysis was implemented.Results: The greatest impact on the quality of the resident’s lived experiences emanates from the physical, organisational and social environments in which they reside. Limited resources, poor staff attitudes and routines that are enforced both on the staff of the facility and the residents appear to reduce optimal functioning within the facility. Furthermore the residents’ intrinsic motivation, presence of enforced idleness, learned helplessness and institutionalisation is often intensified and becomes characteristic of the residents lived experiences.Discussion: The lived experiences of the residents are described according to quality of life indicators that were identified during the study and supported by literature. These include the influence of the physical, social and organizational environments on the residents’ functional status, which comprises physical well-being and emotional well-being and engagement in meaningful occupations including social interaction and relationships with other individuals.Conclusions: Findings of this study may be valuable in understanding and facilitating a positive change in service delivery within chronic care centres.Keywords: chronic care, institutionalisation, lived experiences, residents, occupational deprivatio

Terpyridyl complexes as antimalarial agents

A number of transition metals and their terpyridyl complexes have been evaluated for antimalarial activity on the strain 3D7. The metals, ligands and complexes were each in turn investigated for their efficacy. All activities were in the sub-micromolar range (0.1-1 µM). Their modes of action were compared with that of chloroquine to discover whether or not they were capable of inhibiting haemozoin formation. The data indicate that efficacy could be a result of several mechanisms and that speciation of the metal complex and the manner in which the agents are added to the parasitic broth have a profound effect on the activity of the agents. We believe that our study offers a template by which other researchers should approach their experiments using transition metal complex agents

Hen egg white bovine colostrum supplement reduces symptoms of mild/moderate COVID-19: a randomized control trial

Aim: The ability of a hen egg white bovine colostrum supplement to prevent severe COVID-19 was tested in a double-blind randomized control study. Methods: Adults with mild/moderate COVID-19, risk factors for severe disease, and within 5 days of symptom onset were assigned to the intervention (n = 77) or placebo (n = 79) arms. Symptoms were documented until day 42 post-enrollment and viral clearance was assessed at 11-13 days post-symptom onset. Results: One participant developed severe COVID-19. The severe-type symptom score was lower in the active arm at 11-13 days post-symptom onset (p = 0.049). Chest pain, fever/chills, joint pain/malaise, and sore throat were significantly less frequent in the active arm. No differences in viral clearance were observed. Conclusion: The intervention reduced symptoms of mild/moderate COVID-19

Mass and Charge in Brane-World and Non-Compact Kaluza-Klein Theories in 5 Dim

In classical Kaluza-Klein theory, with compactified extra dimensions and without scalar field, the rest mass as well as the electric charge of test particles are constants of motion. We show that in the case of a large extra dimension this is no longer so. We propose the Hamilton-Jacobi formalism, instead of the geodesic equation, for the study of test particles moving in a five-dimensional background metric. This formalism has a number of advantages: (i) it provides a clear and invariant definition of rest mass, without the ambiguities associated with the choice of the parameters used along the motion in 5D and 4D, (ii) the electromagnetic field can be easily incorporated in the discussion, and (iii) we avoid the difficulties associated with the "splitting" of the geodesic equation. For particles moving in a general 5D metric, we show how the effective rest mass, as measured by an observer in 4D, varies as a consequence of the large extra dimension. Also, the fifth component of the momentum changes along the motion. This component can be identified with the electric charge of test particles. With this interpretation, both the rest mass and the charge vary along the trajectory. The constant of motion is now a combination of these quantities. We study the cosmological variations of charge and rest mass in a five-dimensional bulk metric which is used to embed the standard k = 0 FRW universes. The time variations in the fine structure "constant" and the Thomson cross section are also discussed.Comment: V2: References added, discussion extended. V3 is identical to V2, references updated. To appear in General Relativity and Gravitatio

Renormalization Group Approach to Causal Viscous Cosmological Models

The renormalization group method is applied to the study of homogeneous and flat Friedmann-Robertson-Walker type Universes, filled with a causal bulk viscous cosmological fluid. The starting point of the study is the consideration of the scaling properties of the gravitational field equations, of the causal evolution equation of the bulk viscous pressure and of the equations of state. The requirement of scale invariance imposes strong constraints on the temporal evolution of the bulk viscosity coefficient, temperature and relaxation time, thus leading to the possibility of obtaining the bulk viscosity coefficient-energy density dependence. For a cosmological model with bulk viscosity coefficient proportional to the Hubble parameter, we perform the analysis of the renormalization group flow around the scale invariant fixed point, therefore obtaining the long time behavior of the scale factor.Comment: 19 pages. RevTeX4. Revised version. Accepted in Classical and Quantum Gravit

Neurophysiologic, phenomenological, cultural, social and spiritual correlates of empathy experiences: integral psychological and person centered perspectives

The main objective of this research was to explore neurophysiologic, phenomenological, cultural and social correlates of recipients’ experiences of empathy within the context of Wilber’s Integral approach and Person Centered theory and practice. Thirteen psychologists participated as co-researchers in a triangulated, within subjects’ post-test experimental design in which empathy data were compared with data from control conditions of factual information processing and rest. A consistent pattern emerged from data gathered. Empathy experiences were associated with an unexpected, statistically significant increase in alpha activity, with some associated increasing trends in theta and beta activity. Expected findings were significant decreases in delta activity accompanied by decreasing  trends in gamma wave activity, muscle tension, heart and respiration rate. Individual experiences generally reflected an affective, interpersonal,  cultural, social and spiritual state of normal waking consciousness. Participant consensus was that the neurophysiologic and other correlates corresponded truthfully with typical empathic moments, insights and/or peak experiences, which are associated with effective therapeutic change in traditional and contemporary healing contexts.Key words: Neurophysiologic, phenomenological, cultural, social, spiritual, correlates, empathy experiences, integral psychology, person centered psychotherap