The future cost of cancer in South Africa: An interdisciplinary cost management strategy

The exponential rise in cancer costs in South Africa (SA) was illustrated in a recent Sunday Times article entitled ‘The cost of cancer can be a debt sentence’.[1] Our minister of health talks of a ‘war’ against the high costs of cancer drugs, and epidemiologists project a sharply rising incidence. Eminent international medical journals, such as The Lancet, underline the fact that cancer cost is a growing international problem that confronts even the richest countries. Indeed, the question may be posed: if richer countries in the world are battling to cover the costs of cancer, what is the prognosis for SA

The effects of HIV/AIDS on the clinical profile and outcomes post pericardiectomy of patients with constrictive pericarditis: a retrospective review.

OBJECTIVE: The clinical profile and surgical outcomes of patients with constrictive pericarditis were compared in HIV-positive and -negative individuals. METHODS: This study was a retrospective analysis of patients diagnosed with constrictive pericarditis at Inkosi Albert Luthuli Central Hospital, Durban, over a 10-year period (2004-2014). RESULTS: Of 83 patients with constrictive pericarditis, 32 (38.1%) were HIV positive. Except for pericardial calcification, which was more common in HIV-negative subjects (n = 15, 29.4% vs n = 2, 6.3%; p = 0.011), the clinical profile was similar in the two groups. Fourteen patients died preoperatively (16.9%) and three died peri-operatively (5.8%). On multivariable analysis, age (OR 1.17; 95% CI: 1.03-1.34; p = 0.02), serum albumin level (OR 0.63; 95% CI: 0.43-0.92; p = 0.016), gamma glutamyl transferase level (OR 0.97; 95% CI: 0.94-0.1.0; p = 0.034) and pulmonary artery pressure (OR 1.49; 95% CI: 1.07-2.08; p = 0.018) emerged as independent predictors of pre-operative mortality rate. Peri-operative complications occurred more frequently in HIV-positive patients [9 (45%) vs 6 (17.6%); p = 0.030]. CONCLUSIONS: Without surgery, tuberculous constrictive pericarditis was associated with a high mortality rate. Although peri-operative complications occurred more frequently, surgery was not associated with increased mortality rates in HIV-positive subjects

Participation and co-production in climate adaptation:Scope and limits identified from a meta-method review of research with European coastal communities

As climate change impacts increase, there are growing calls for strengthening relationships between researchers and other stakeholders to advance adaptation efforts. Participation and co-production are widely held to be key to such relationships, both intended to open substantive engagement in science and research to non-experts. Gains commonly attributed to participation and co-production include improved understanding of user needs and contexts, enhanced trust, creating actionable knowledge for adaptation planning and decision-making, and other new outcomes and practices supporting adaptation progress. At the same time, scrutiny of existing efforts to use participation and co-production reveals limits and gaps in understanding the conditions and processes required to undertake them in meaningful, appropriate and effective ways. This review assesses such limitations and gaps across the growing volume of research focused on adapting coastal and island communities within Europe. We systematically reviewed 60 peer-reviewed papers, drawing on a novel meta-method review approach to synthesise patterns in participation and co-production implementations, types of outcomes, and the latter’s associations with study research designs. We identify a propensity towards using more simplistic definitions of community, more conventional, extractive research methods in working with study communities, and emphasising knowledge generation over other outcomes. These issues are all limits on participation and co-production effectiveness, and we make recommendations to reduce them. We also recommend further recourse to systematic review methods to aid the development of participation and co-production knowledge for adaptation

Participation and co-production in climate adaptation:Scope and limits identified from a meta-method review of research with European coastal communities

As climate change impacts increase, there are growing calls for strengthening relationships between researchers and other stakeholders to advance adaptation efforts. Participation and co-production are widely held to be key to such relationships, both intended to open substantive engagement in science and research to non-experts. Gains commonly attributed to participation and co-production include improved understanding of user needs and contexts, enhanced trust, creating actionable knowledge for adaptation planning and decision-making, and other new outcomes and practices supporting adaptation progress. At the same time, scrutiny of existing efforts to use participation and co-production reveals limits and gaps in understanding the conditions and processes required to undertake them in meaningful, appropriate and effective ways. This review assesses such limitations and gaps across the growing volume of research focused on adapting coastal and island communities within Europe. We systematically reviewed 60 peer-reviewed papers, drawing on a novel meta-method review approach to synthesise patterns in participation and co-production implementations, types of outcomes, and the latter’s associations with study research designs. We identify a propensity towards using more simplistic definitions of community, more conventional, extractive research methods in working with study communities, and emphasising knowledge generation over other outcomes. These issues are all limits on participation and co-production effectiveness, and we make recommendations to reduce them. We also recommend further recourse to systematic review methods to aid the development of participation and co-production knowledge for adaptation

Ecology of Alopoglossus angulatus and A. atriventris (Squamata, Gymnophthalmidae) in western Amazonia

We studied the ecology of Alopoglossus angulatus and A. atriventris in western Amazonia. Both species are found in leaf litter of lowland tropical forest, but A. angulatus tends to be found near water whereas A. atriventris is found in terra firme forest. Both tend to be active in shade on sunny and cloudy days. Body size of adults differs (A. angulatus larger), but species differences in sizeadjusted morphology are minor. Sexual dimorphism exists in relative head length (males larger) only in A. atriventris. Diets are similar, with roaches, spiders, grasshoppers/crickets, and springtails dominating the diet. Overall, these lizards are similar ecologically even though they occur together at many sites. Leaf litter and shaded forest appear to be requisites for survival at the local level

Ecology of Alopoglossus angulatus and A. atriventris (Squamata, Gymnophthalmidae) in western Amazonia

We studied the ecology of Alopoglossus angulatus and A. atriventris in western Amazonia. Both species are found in leaf litter of lowland tropical forest, but A. angulatus tends to be found near water whereas A. atriventris is found in terra firme forest. Both tend to be active in shade on sunny and cloudy days. Body size of adults differs (A. angulatus larger), but species differences in sizeadjusted morphology are minor. Sexual dimorphism exists in relative head length (males larger) only in A. atriventris. Diets are similar, with roaches, spiders, grasshoppers/crickets, and springtails dominating the diet. Overall, these lizards are similar ecologically even though they occur together at many sites. Leaf litter and shaded forest appear to be requisites for survival at the local level

Does depression diagnosis and antidepressant prescribing vary by location? Analysis of ethnic density associations using a large primary-care dataset

BACKGROUND: Studies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs. METHOD: Using a dataset of GP records for all patients registered in Lambeth, Hackney, Tower Hamlets and Newham in 2013 we investigated new diagnoses of depression and antidepressant use for: Indian, Pakistani, Bangladeshi, black Caribbean and black African patients. Neighbourhood effects were assessed independently of GP practice using a cross-classified multilevel model. RESULTS: Black and minority ethnic groups are up to four times less likely to be newly diagnosed with depression or prescribed antidepressants compared to white British patients. We found an inverse relationship between neighbourhood ethnic density and new depression diagnosis for some groups, where an increase of 10% own-ethnic density was associated with a statistically significant (p < 0.05) reduced odds of depression for Pakistani [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.70-0.93], Indian (OR 0.88, CI 0.81-0.95), African (OR 0.88, CI 0.78-0.99) and Bangladeshi (OR 0.94, CI 0.90-0.99) patients. Black Caribbean patients, however, showed the opposite effect (OR 1.26, CI 1.09-1.46). The results for antidepressant use were very similar although the corresponding effect for black Caribbeans was no longer statistically significant (p = 0.07). CONCLUSION: New depression diagnosis and antidepressant use was shown to be less likely in areas of higher own-ethnic density for some, but not all, ethnic groups

Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET‐DD) study, a collaborative study carried out in 14 countries

Aims To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries. Methods People with diabetes aged 18–65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale. Demographic and medical record data were collected. Results A total of 2783 people with Type 2 diabetes (45.3% men, mean duration of diabetes 8.8 years) participated. Overall, 10.6% were diagnosed with current major depressive disorder and 17.0% reported moderate to severe levels of depressive symptomatology (Patient Health Questionnaire scores >9). Multivariable analyses showed that, after controlling for country, current major depressive disorder was significantly associated with gender (women) (PPPPP<0.0001). The proportion of those with either current major depressive disorder or moderate to severe levels of depressive symptomatology who had a diagnosis or any treatment for their depression recorded in their medical records was extremely low and non-existent in many countries (0–29.6%). Conclusions Our international study, the largest of this type ever undertaken, shows that people with diabetes frequently have depressive disorders and also significant levels of depressive symptoms. Our findings indicate that the identification and appropriate care for psychological and psychiatric problems is not the norm and suggest a lack of the comprehensive approach to diabetes management that is needed to improve clinical outcomes

The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance

Approximately 10% of antimicrobials used by humans in low- and middle-income countries are estimated to be substandard or falsified. In addition to their negative impact on morbidity and mortality, they may also be important drivers of antimicrobial resistance. Despite such concerns, our understanding of this relationship remains rudimentary. Substandard and falsified medicines have the potential to either increase or decrease levels of resistance, and here we discuss a range of mechanisms that could drive these changes. Understanding these effects and their relative importance will require an improved understanding of how different drug exposures affect the emergence and spread of resistance and of how the percentage of active pharmaceutical ingredients in substandard and falsified medicines is temporally and spatially distributed

Frequency locking of modulated waves

We consider the behavior of a modulated wave solution to an $\mathbb{S}^1$-equivariant autonomous system of differential equations under an external forcing of modulated wave type. The modulation frequency of the forcing is assumed to be close to the modulation frequency of the modulated wave solution, while the wave frequency of the forcing is supposed to be far from that of the modulated wave solution. We describe the domain in the three-dimensional control parameter space (of frequencies and amplitude of the forcing) where stable locking of the modulation frequencies of the forcing and the modulated wave solution occurs. Our system is a simplest case scenario for the behavior of self-pulsating lasers under the influence of external periodically modulated optical signals