bluuebunny/crossref_metadata_2025 huggingface dataset:
Platelet testing in flow diversion: a review of the evidence
Authors: Taylor L. Ian , Dickerson James C. , Dambrino Robert J. , Kalani M. Yashar S. , Taussky Philipp , Washington Chad W. , Park Min S.
Published: June 2017

OBJECTIVE

Although the use of dual antiplatelet therapy with flow diversion is recommended and commonplace, the testing of platelet inhibition is more controversial.

METHODS

The authors reviewed the medical literature to establish and describe the physiology of platelet adhesion, the pharmacology of antiplatelet medications, and the mechanisms of the available platelet function tests. Additionally, they present a review of the pertinent neurointerventional and interventional cardiology literature.

RESULTS

Competing reports in the neurointerventional literature argue for and against the use of routine platelet function testing, with adjustments to the dosage or medications based on the results. The interventional cardiology literature has also wrestled with this dilemma after percutaneous coronary interventions, with conflicting reports of the benefits of platelet function testing.

CONCLUSIONS

Despite its prevalence, the benefits of platelet function testing prior to flow diversion are unproven. This practice will likely remain controversial until the level of evidence improves through more rigorous testing and reporting.
Endovascular treatment of blister aneurysms
Authors: Peitz Geoffrey W. , Sy Christopher A. , Grandhi Ramesh
Published: June 2017

Blister aneurysms are rare cerebrovascular lesions for which the treatment methods are reviewed here, with a focus on endovascular options. The reported pathogenesis of blister aneurysms varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. There is consensus on the excessive fragility of blister aneurysms and their parent vessels, which makes clipping technically difficult. Open surgical treatment is associated with high rates of complications, morbidity, and mortality; endovascular treatment is a promising alternative. Among endovascular treatment options, deconstructive treatment has been associated with higher morbidity compared with reconstructive methods such as direct embolization, stent- or balloon-assisted direct embolization, stent monotherapy, and flow diversion. Flow diversion has been associated with higher technical success rates and similar clinical outcomes compared with non–flow diverting treatment methods. However, delayed aneurysm occlusion and the need for antiplatelet therapy are potential drawbacks to flow diversion that must be considered when choosing among treatment methods for blister aneurysms.
Thermosensitive Hydrogel Mask Significantly Improves Skin Moisture and Skin Tone; Bilateral Clinical Trial
Authors: Quattrone Anna , Czajka Anna , Sibilla Sara
Published: June 2017

Objective: A temperature-sensitive state-changing hydrogel mask was used in this study. Once it comes into contact with the skin and reaches the body temperature, it uniformly and quickly releases the active compounds, which possess moisturizing, anti-oxidant, anti-inflammatory and regenerative properties. Methods: An open label clinical trial was conducted to evaluate the effects of the test product on skin hydration, skin tone and skin ageing. Subjects applied the product to one side of their face and underwent Corneometer® and Chromameter measurements, Visual assessment of facial skin ageing and facial photography. All assessments and Self-Perception Questionnaires (SPQ) were performed at baseline, after the first application of the test product and after four applications. Results: After a single treatment we observed an increase in skin moisturisation, an improvement of skin tone/luminosity and a reduction in signs of ageing, all statistically significant. After four applications a further improvement in all measured parameters was recorded. These results were confirmed by the subjects’ own perceptions, as reported in the SPQ both after one and four applications. Conclusion: The hydrogel mask tested in this study is very effective in improving skin hydration, skin radiance and luminosity, in encouraging an even skin tone and in reducing skin pigmentation.
Meta-Analyses of QTLs Associated with Protein and Oil Contents and Compositions in Soybean [Glycine max (L.) Merr.] Seed
Authors: Van Kyujung , McHale Leah
Published: June 2017

Soybean [Glycine max (L.) Merr.] is a valuable and nutritious crop in part due to the high protein meal and vegetable oil produced from its seed. Soybean producers desire cultivars with both elevated seed protein and oil concentrations as well as specific amino acid and fatty acid profiles. Numerous studies have identified quantitative trait loci (QTLs) associated with seed composition traits, but validation of these QTLs has rarely been carried out. In this study, we have collected information, including genetic location and additive effects, on each QTL for seed contents of protein and oil, as well as amino acid and fatty acid compositions from over 80 studies. Using BioMercator V. 4.2, a meta-QTL analysis was performed with genetic information comprised of 175 QTLs for protein, 205 QTLs for oil, 156 QTLs for amino acids, and 113 QTLs for fatty acids. A total of 55 meta-QTL for seed composition were detected on 6 out of 20 chromosomes. Meta-QTL possessed narrower confidence intervals than the original QTL and candidate genes were identified within each meta-QTL. These candidate genes elucidate potential natural genetic variation in genes contributing to protein and oil biosynthesis and accumulation, providing meaningful information to further soybean breeding programs.
Dynamical Modeling and Analysis of Viscoelastic Properties of Single Cells
Authors: Wang Bo , Wang Wenxue , Wang Yuechao , Liu Bin , Liu Lianqing
Published: June 2017

A single cell can be regarded as a complex network that contains thousands of overlapping signaling pathways. The traditional methods for describing the dynamics of this network are extremely complicated. The mechanical properties of a cell reflect the cytoskeletal structure and composition and are closely related to the cellular biological functions and physiological activities. Therefore, modeling the mechanical properties of single cells provides the basis for analyzing and controlling the cellular state. In this study, we developed a dynamical model with cellular viscoelasticity properties as the system parameters to describe the stress-relaxation phenomenon of a single cell indented by an atomic force microscope (AFM). The system order and parameters were identified and analyzed. Our results demonstrated that the parameters identified using this model represent the cellular mechanical elasticity and viscosity and can be used to classify cell types.
Chemical Methods to Knock Down the Amyloid Proteins
Authors: Gao Na , Chen Yong-Xiang , Zhao Yu-Fen , Li Yan-Mei
Published: June 2017

Amyloid proteins are closely related with amyloid diseases and do tremendous harm to human health. However, there is still a lack of effective strategies to treat these amyloid diseases, so it is important to develop novel methods. Accelerating the clearance of amyloid proteins is a favorable method for amyloid disease treatment. Recently, chemical methods for protein reduction have been developed and have attracted much attention. In this review, we focus on the latest progress of chemical methods that knock down amyloid proteins, including the proteolysis-targeting chimera (PROTAC) strategy, the “recognition-cleavage” strategy, the chaperone-mediated autophagy (CMA) strategy, the selectively light-activatable organic and inorganic molecules strategy and other chemical strategies.
Competence-Based Pharmacy Education in the University of Helsinki
Authors: Katajavuori Nina , Salminen Outi , Vuorensola Katariina , Huhtala Helena , Vuorela Pia , Hirvonen Jouni
Published: June 2017

In order to meet the expectations to act as an expert in the health care profession, it is of utmost importance that pharmacy education creates knowledge and skills needed in today’s working life. Thus, the planning of the curriculum should be based on relevant and up-to-date learning outcomes. In the University of Helsinki, a university wide curriculum reform called ‘the Big Wheel’ was launched in 2015. After the reform, the basic degrees of the university are two-cycle (Bachelor–Master) and competence-based, where the learning outcomes form a solid basis for the curriculum goals and implementation. In the Faculty of Pharmacy, this curriculum reform was conducted in two phases during 2012–2016. The construction of the curriculum was based on the most relevant learning outcomes concerning working life via high quality first (Bachelor of Science in Pharmacy) and second (Master of Science in Pharmacy) cycle degree programs. The reform was kicked off by interviewing all the relevant stakeholders: students, teachers, and pharmacists/experts in all the working life sectors of pharmacy. Based on these interviews, the intended learning outcomes of the Pharmacy degree programs were defined including both subject/contents-related and generic skills. The curriculum design was based on the principles of constructive alignment and new structures and methods were applied in order to foster the implementation of the learning outcomes. During the process, it became evident that a competence-based curriculum can be created only in close co-operation with the stakeholders, including teachers and students. Well-structured and facilitated co-operation amongst the teachers enabled the development of many new and innovative teaching practices. The European Union funded PHAR-QA project provided, at the same time, a highly relevant framework to compare the curriculum development in Helsinki against Europe-wide definitions of competences and learning outcomes in pharmacy education.
The Catholic Church and Technological Progress: Past, Present, and Future
Authors: Green Brian
Published: June 2017

Over 2000 years the Catholic Church has slowly developed a posture towards technology which is predominantly techno-optimist and techno-progressive, and yet the Church does not have this reputation today. Concomitantly, Church institutions and individuals have made crucial contributions to the advance of science and technology, yet despite this practical effort to better human development, Christian theology has been remarkably uninterested in the subject of technology. This lack of interest is no longer tenable; scholars of religion and theologians should seriously engage technology because it is empowering humanity in ways that were previously reserved only for gods. This blind spot has not only hampered the Church’s ability to understand itself and our world, but also impeded the ability of the Church to fulfill its mission. Pope Francis’s 2015 encyclical Laudato Si has begun to address this neglect, but is best understood in the context of Christian history, not only as written, but more so as practiced.
Design and Implementation of a Hypothermic Machine Perfusion Device for Clinical Preservation of Isolated Organs
Authors: Shen Fei , Yan Ruqiang
Published: June 2017

The imbalance between limited organ supply and huge potential need has hindered the development of organ-graft techniques. In this paper a low-cost hypothermic machine perfusion (HMP) device is designed and implemented to maintain suitable preservation surroundings and extend the survival life of isolated organs. Four necessary elements (the machine perfusion, the physiological parameter monitoring, the thermostatic control and the oxygenation apparatus) involved in this HMP device are introduced. Especially during the thermostatic control process, a modified Bayes estimation, which introduces the concept of improvement factor, is realized to recognize and reduce the possible measurement errors resulting from sensor faults and noise interference. Also, a fuzzy-PID controller contributes to improve the accuracy and reduces the computational load using the DSP. Our experiments indicate that the reliability of the instrument meets the design requirements, thus being appealing for potential clinical preservation applications.
Structural Health Monitoring for a Z-Type Special Vehicle
Authors: Yuan Chaolin , Ren Liang , Li Hongnan
Published: June 2017

Nowadays there exist various kinds of special vehicles designed for some purposes, which are different from regular vehicles in overall dimension and design. In that case, accidents such as overturning will lead to large economical loss and casualties. There are still no technical specifications to follow to ensure the safe operation and driving of these special vehicles. Owing to the poor efficiency of regular maintenance, it is more feasible and effective to apply real-time monitoring during the operation and driving process. In this paper, the fiber Bragg grating (FBG) sensors are used to monitor the safety of a z-type special vehicle. Based on the structural features and force distribution, a reasonable structural health monitoring (SHM) scheme is presented. Comparing the monitoring results with the finite element simulation results guarantees the accuracy and reliability of the monitoring results. Large amounts of data are collected during the operation and driving progress to evaluate the structural safety condition and provide reference for SHM systems developed for other special vehicles.
A Dynamic Programming Model for Operation Decision-Making in Bicycle Sharing Systems under a Sustainable Development Perspective
Authors: Li Linfeng , Shan Miyuan , Li Ying , Liang Sheng
Published: June 2017

Maintaining a balance between revenue and expenditure is the key to the sustainable development of a bicycle sharing system (BSS), and is a challenge for almost all systems worldwide. This article proposes a dynamic programming approach to obtain the optimal strategy to maximize the revenue of overall BSS. The Variable Granularity-Depth First Search (VG-DFS) algorithm is designed to speed up the solution. A numerical experiment is presented to verify the applicability of the model through a comparison with real data from the BSS in Hangzhou. Results indicated that the BSS could achieve break-even, or even obtain a substantial income by utilizing our model to make operational decisions, especially when the region it is located in has a relatively high GDP. Moreover, the best investment strategy proved is to involve stations in the initial construction period of the BSS as much as possible.
Towards a Multipolar Model of Cultural Mediators within Multicultural Spaces. Cultural Mediators in Belgium, 1830-1945
Authors: Verschaffel Tom , Meylaerts Reine , Lobbes Tessa , Gonne Maud , Hulst Lieven d'
Published: June 2017

Naar een multipolaire benadering van culturele bemiddelaars in multiculturele ruimtes. Culturele bemiddelaars in België, 1830-1945.

In dit artikel wordt een diepgaand conceptueel en methodologisch begrip van de culturele bemiddelaar beoogd. Deze bemiddelaar wordt hier als een persoon gedefinieerd die taalkundige, artistieke en politiek-geografische grenzen overschrijdt en die culturele uitwisselingen onderneemt. Vooral in een heterogene context, waar verschillende talen en culturele velden op elkaar inwerken zoals in het België van de late negentiende en de eerste helft van de twintigste eeuw, ondernamen culturele bemiddelaars belangrijke uitwisselingsactiviteiten waardoor ze een bijdrage leverden tot de vaak gelijktijdige constructie van regionale, nationale en internationale culturele identiteiten. Na eerst enkele kritieken op verschillende aspecten van cultuurhistorisch, literair-historisch en vertaalwetenschappelijk onderzoek naar culturele bemiddelaars te hebben geformuleerd, stellen we een multipolair model voor dat volgens ons een vruchtbare manier kan zijn om culturele bemiddelaars te bestuderen. De interdisciplinaire onderzoeksperspectieven, zoals voorgesteld in dit model, worden vervolgens aan de hand van enkele korte studies van culturele bemiddelaars, hun interculturele uitwisselingen en hun positie in het negentiende-eeuwse en twintigsteeeuwse België geïllustreerd, om zo een aanzet te geven tot een beter begrip van de veranderende organisatie en praktijken van het Belgische culturele leven doorheen de tijd.
A concise and practical stereoselective synthesis of ipragliflozin L-proline
Authors: Ma Shuai , Liu Zhenren , Pan Jing , Zhang Shunli , Zhou Weicheng
Published: June 2017

A concise and practical stereoselective synthesis of ipragliflozin L-proline was presented starting from 2-[(5-iodo-2-fluorophenyl)methyl]-1-benzothiophene and 2,3,4,6-tetra-O-pivaloyl-α-D-glucopyranosyl bromide without catalyst via iodine–lithium–zinc exchange. The overall yield was 52% in three steps and the product purity was excellent. Two key diastereomers were prepared with efficient and direct access to the α-C-arylglucoside.
Disparus, mort négligée et rituels en Argentine. De la quête à l’exhumation des corps
Authors: Panizo Laura Marina
Published: June 2017

Dans cet article, je vais parler de l’expérience de deux groupes de parents de disparus durant la dernière dictature militaire en Argentine (1976-1982), en m’intéressant à la problématique de la mort en contexte de mort violente, à l’absence de corps et à l’impact des exhumations et des identifications réalisées par l’équipe médico-légale argentine d’anthropologie (EAAF) à un niveau personnel et collectif. D’une part, nous verrons comment à travers un répertoire symbolique, les familles de victimes tissent un type particulier de relation avec leurs proches, donnent sens à l’histoire récente et se considèrent comme membres d’un groupe social particulier. D’autre part, nous verrons comment l’absence de corps et le cadre d’interprétation symbolique produisent une confrontation avec la mort que j’appelle la mort négligée, laquelle peut être transformée à travers l’exhumation et l’identification du corps.
La force du symbole
Authors: Bazart Cécile , Bonein Aurélie
Published: June 2017

Partant des constats d’hétérogénéité en termes d’honnêteté des contribuables et d’existence d’une dynamique sociale perverse poussant les plus honnêtes à la sous-déclaration, nous proposons un mécanisme simple afin de l’enrayer. Dans cette expérience en laboratoire, nous testons la propension des sujets à contribuer de manière volontaire à un fonds destiné à financer la lutte contre la fraude fiscale. Ce mécanisme de contribution, volontaire et sans redistribution, fait l’objet de plusieurs traitements qui diffèrent quant aux modalités et au niveau de la contribution. Nous montrons : 1) qu’un nombre conséquent de sujets contribuent au fonds, et ce, de manière décroissante avec le montant de la contribution, 2) que ce sont les contribuables les plus honnêtes qui contribuent et enfin 3) que l’aversion pour le risque dissuade les individus de contribuer, alors qu’au contraire l’aversion pour l’inégalité les y encourage. Enfin, dans la lignée de la littérature sur la fraude fiscale, nous confirmons que l’élévation de la probabilité de détection, qui n’est observée que dans les groupes où la contribution collective au fonds est suffisante, réduit la fraude dans ces groupes.
Testimonium testimonii
Authors: Lavaud Laurent
Published: June 2017

Cet article se propose d’explorer l’idée de témoignage chez Marius Victorinus en en distinguant trois modalités. La première est le témoignage  de Jean-Baptiste. Jean est « écho de la voix », c’est-à-dire qu’il est l’image de l’expression première de Dieu qui est le Christ. L’enjeu de ce premier témoignage est la reconnaissance de l’identité du Christ et la profession de son statut de Fils de Dieu. Cette première modalité du témoignage n’est cependant possible que par la condition du témoignage de l’Esprit Saint. Celui-ci est « voix de la voix » : c’est-à-dire qu’il est la reprise intérieure, spirituelle, de ce qui se trouve déployé dans l’extériorité du monde par le Christ. Enfin, la troisième dimension du témoignage suppose de mobiliser la théologie trinitaire propre à Victorinus : le témoignage au sujet du Christ dans l’économie du salut n’est lui-même possible que sur la base de l’intelligence première de la vie du Fils dans l’être immanent de Dieu. La méditation victorinienne du témoignage permet ainsi d’articuler le plan de la doctrine trinitaire et le plan de l’advenue du salut.
Villa en Rímini
Authors: Gandolfi Giovanni
Published: June 2017

Esta villa, de carácter residencial, se encuentra enclavada en la avenida del Príncipe Amadeo, de Rímini. En sus tres plantas se distribuyen: en la baja, los servicios y garaje; en la primera, la vivienda del propietario, amplia y magníficamente condicionada, y la segunda se dedica a alquiler.
Canalización y aprovechamientos del río Weser
Authors: Würfel H.
Published: June 2017

El tramo inferior del rio Weser, situado en la provincia de Hannover (Alemania) en su mayor parte, de unos 160 km de longitud, presenta un cauce muy tortuoso y de bastante desnivel.
Prophylactic Acid-Suppressive Therapy in Hospitalized Adults: Indications, Benefits, and Infectious Complications
Authors: Faust Andrew C. , Echevarria Kelly L. , Attridge Rebecca L. , Sheperd Lyndsay , Restrepo Marcos I.
Published: June 2017

Acid-suppressive therapy for prophylaxis of stress ulcer bleeding is commonly prescribed for hospitalized patients. Although its use in select, at-risk patients may reduce clinically significant gastrointestinal bleeding, the alteration in gastric pH and composition may place these patients at a higher risk of infection. Although any pharmacologic alteration of the gastric pH and composition is associated with an increased risk of infection, the risk appears to be highest with proton pump inhibitors, perhaps owing to the potency of this class of drugs in increasing the gastric pH. With the increased risk of infection, universal provision of pharmacologic acid suppression to all hospitalized patients, even all critically ill patients, is inappropriate and should be confined to patients meeting specific criteria. Nurses providing care in critical care areas may be instrumental in screening for appropriate use of acid-suppressive therapy and ensuring the drugs are discontinued upon transfer out of intensive care or when risk factors are no longer present.
Machines for non-chemical intra-row weed control in narrow and wide-row crops: a review
Authors: Peruzzi Andrea , Martelloni Luisa , Frasconi Christian , Fontanelli Marco , Pirchio Michel , Raffaelli Michele
Published: June 2017

Intra-row weed control in organic or low-input cropping systems is more difficult than in conventional agriculture. The various mechanical and thermal devices available for intra-row weed control are reported in this review. Low-tech mechanical devices such as cultivators, finger-weeders, brush weeders, and torsionweeders tend to be used in low density crops, while spring-tine harrows are mainly applied in narrow-row high-density crops. Flame weeding can be used for both narrow and wide-row sown crops, provided that the crop is heat-tolerant. Robotic weeders are the most recent addition to agricultural engineering, and only a few are available on the market. Nowadays, robotic weeders are not yet used in small and medium sized farms. In Europe, highincome niche crops are often cultivated in small farms and farmers cannot invest in high-tech solutions. Irrespectively of the choice of low- or high-tech machines, there are several weeders that can be used to reduce the use of herbicides, making of them a judicious use, or decide to avoid them.
A method for handlebars ballast calculation in order to reduce vibrations transmissibility in walk behind tractors
Authors: Fabbri Angelo , Cevoli Chiara , Cantalupo Giuseppe
Published: June 2017

Walk behind tractors have some advantages over other agricultural machines, such as the cheapness and the easy to use, however the driver is exposed to high level of vibrations transmitted from handles to hand-arm system and to shoulders. The vibrations induce discomfort and early fatigue to the operator. In order to control the vibration transmissibility, a ballast mass may be added to the handles. Even if the determination of the appropriate ballast mass is a critical point in the handle design. The aim of this research was to study the influence of the handle mass modification, on the dynamic structure behaviour. Modal frequencies and subsequent transmissibility calculated by using an analytical approach and a finite elements model, were compared. A good agreement between the results obtained by the two methods was found (average percentage difference calculated on natural frequencies equal to 5.8±3.8%). Power tillers are made generally by small or medium-small size manufacturers that have difficulties in dealing with finite element codes or modal analysis techniques. As a consequence, the proposed analytical method could be used to find the optimal ballast mass in a simple and economic way, without experimental tests or complex finite element codes. A specific and very simple software or spreadsheet, developed on the base of the analytical method here discussed, could effectively to help the manufacturers in the handlebar design phase. The choice of the correct elastic mount, the dimensioning of the guide members and the ballast mass could be considerably simplified.
The chronic leukaemias
Authors: Jacobs Peter , Wood Lucille
Published: June 2017

The slow progression of both chronic granulocytic and lymphocytic leukaemia, when compared to their acute counterparts, has been used as an argument to support less aggressive therapy or even, in some instances, a watch-and-wait policy. This conservative approach is bolstered by a number of observations including the ease with which haematologic control can initially be achieved, the older age of patients with the lymphocytic variant and the paucity of controlled data showing that long disease-free survival or cure can result from the use of aggressive treatment. Given these circumstances, it is not surprising that many such individuals are managed outside specialised centres using a variety of agents and schedules, both of which may, on occasions, be inappropriate. Accumulating evidence suggests a need to reconsider these practices since cure is now possible in selected patients with chronic granulocytic leukaemia while the use of multi-drug regimens in the lymphatic form can significantly improve survival. These advances are the result of carefully conducted clinical trials involving many individuals the world over and constitute the basis fo r advocating early referral to those institutions where all the necessary expertise is available.
The quality of nursing care of the frail aged in selected institutions in Eastern Cape and Natal
Authors: Hunt Noelle B. , Uys Leana R.
Published: June 2017

An investigation was undertaken to establish standards for the care of the frail aged and to develop an instrument to measure this care. In this process the care in 12 institutions was monitored. In general, the care was found to be o f good quality, with an average o f 74,3%, but there are residences where the percentage is up to 10% lower. The influence o f some internal and external factors on the quality o f care were investigated.
Die Uitdrukking ‘al tírā’ in die Ou Testament
Authors: Mulder E. S.
Published: June 2017

No abstract available.
Boekbesprekings
Authors: Dreyer P. S. , Pont A. D. , Erasmus D. F. , Engelbrecht B. J. , Oberholzer J. P.
Published: June 2017

No abstract available.
Boekbespreking
Authors: Dreyer P. S. , Gemser B. , Pont A. D.
Published: June 2017

No abstract available.
Die Ou Testamentiese Getuienis aangaande die Nederdaling van Christus na die Hel
Authors: Oberholzer J. P.
Published: June 2017

No abstract available.
Die Verhuising van 'n Nederlandse Gesin na die Zuid-Afrikaansche Republiek in 1890
Authors: Rex H. M.
Published: June 2017

No abstract available.
Die Vraekompleks rondom Artikel III van die Kerkwet
Authors: De Wet J. I. , Pont A. D.
Published: June 2017

No abstract available.
Die ontwikkeling van die menslike bewussyn: Kan die postmodernekerk ruimte bied vir ‘mitologie’? Ken Wilber se bydrae tot die pastoraat
Authors: Ferreira Ignatius W.
Published: June 2017

The development of the human consciousness: Can a ‘postmodern church’ accommodate ‘mythology’? Ken Wilber’s contribution to pastoral carePostmodern theologians like Hal Taussig are not very optimistic about the future of Christianity. To them, the theistic (mythological) understanding of God is of little use in the postmodern world of the 21st century. Taussig prefers the grassroots Christianity, which has room for persons of all sexual orientations, and advocates ecological sensitivity. The question is: What do the followers of this spirituality teach their children about God? The solution is what Wilber calls ‘the conveyer belt’ and God’s ‘Kosmic address’. Everyone starts at square one, ‘traditional’ and grassroots Christians alike, and move along this conveyer belt. Along the way, there are seven stages and three perspectives, i.e. the first, second and third-person perspective, through which human consciousness could evolve. That means that any given person could have one of 21 different possible understandings and experiences of God. A questionnaire could assist pastors to determine at which stage or level of evolution an individual is, as well as the ‘Kosmic address’ that God has for that individual. Through spiritual exercises, pastors could then support the individual’s further growth towards mature human consciousness.
Transversality and interdisciplinary discussion in postfoundational practical theology – reflecting on Julian Müller’s interdisciplinary guidelines
Authors: Van der Westhuizen Zander
Published: June 2017

This article reflected on Julian Müller’s paper on the practical guidelines for conducting interdisciplinary work, a process which is similar to that which the author used during his own PhD studies on mentorship. Beginning this article by discussing postfoundationalism and transversal rationality, the author continued by describing his own process of interdisciplinary conversation, where various scholars participated in the interdisciplinary conversation on mentorship. An interview with a mentor and mentee was used as a local, real narrative in the process. In the final section, the author reflected upon his own process in relation to that of Müller and suggested a process with three movements for interdisciplinary work.
The role of botanic and zoological gardens !n national conservation planning
Authors: Rycroft H.B.
Published: June 2017

I am to talk about botanic and zoological gardens and the role they play, or should play, in the conservation of our wild life in its broadest sense. To get everything straight, let us see in the first place what we mean by a botanic and a zoological garden. The simplest definition of a botanic garden is that of the International Directory of Botanic Gardens (2nd Ed. Fletcher, Henderson, and Prentice) which simply requires a garden to be open to the public and in which the plants are labelled.
Iinterpretation and education in nature conservation
Authors: Geddes Page J.T.
Published: June 2017

It is pleasant to have an opportunity to deal with the subject of interpretation in nature conservation at a time when so many diversified and often ingenious efforts over the years are becoming formalized into systems with specially trained personnel supplied with specific and reasonable budgets to enable them to really get on with the job. Preparations for the writing of this paper have led to the decision that education in nature conservation, although unquestionably running as a thread throughout most of our interpretative efforts is truly a very different approach.
Southern African HIV Clinicians Society Paediatric Discussion Group
Authors: Levin Leon
Published: June 2017

No Abstract available
A window into a public program for prevention of mother to child transmission of HIV: Evidence from a prospective clinical trial
Authors: Cotton M , Kim S , Rabie H , Coetzee J , Nachman S
Published: June 2017

Objectives

To evaluate efficacy of the antenatal, intra-partum and post-natal antiretroviral components of a public service Prevention of Mother to Child (MTCT) program in infants.

Design

Analysis of prospectively collected screening data of demographic and MTCT-related interventions and HIV-infection status of infants identified through HIV-specific DNA polymerase chain reaction.

Setting

Tygerberg Children’s Hospital, Western Cape Province, South Africa.

Subjects

HIV-infected women and their infants identified through participation in a public service MTCT program were referred for possible participation in a prospective study of isoniazid prophylaxis.

Interventions

Key components of the Program include voluntary counselling and testing, zidovudine to the mother from between 28 and 34 weeks gestation and to the newborn infant for the first week, single dose nevirapine to the mother in labour and the newborn shortly after birth and free formula for 6 months.

Main Outcome Measures

Number and percentage of HIV-infected infants and extent of exposure to antenatal, intrapartum and post-natal antiretrovirals.

Results

Of 656 infants with a median age of 12.6 weeks, screened between April 1st 2005 through May 2006, 39 were HIV-infected giving a transmission rate of 5.9% (95% CI: 4.4% - 8.0%). Antenatal prophylaxis was significantly associated with reduced transmission (OR: 0.43 (95% CI: 0.21 - 0.94)) as opposed to intrapartum and postpartum components (p=0.85 and p=0.84, respectively). In multivariable analysis the antenatal component remained significant (OR=0.40 (95% CI 0.19 - 0.90)).

Conclusions

The antenatal phase is the most important antiretroviral component of the MTCT program, allowing most opportunity for intervention.
When to start antiretroviral therapy in infants and children
Authors: Cotton Mark F , Rabie Helena , Feucht Ute , Violari Avy
Published: June 2017

This articles provides a background for antiretroviral therapy in infants and children, incorporating both old and new data. There is increasing data favouring early therapy for all age groups. Below a year of age, all HIV-infected infants should commence therapy and thereafter at higher CD4 thresholds than previous recommendations
Message from the Executive
Authors: Venter Francois
Published: June 2017

Message from the Executive
Rehabilitation: A crucial component in the future of HIV care and support
Authors: Nixon Stephanie , Forman Lisa , Hanass-Hancock Jill , Mac-Seing Muriel , Munyanukato Norbert , Myezwa Hellen , Retis Chiara
Published: June 2017

Provision of antiretroviral therapy (ART) is not an end in itself but a means to achieving improved wellness for people living with HIV. Rehabilitation, broadly defined, is another key contributor to wellness within this context. Understanding the potential for rehabilitation requires that one is able to consider HIV not only within a biomedical model that focuses on body systems, diagnoses and symptoms, but also within a rehabilitation framework that focuses on how these diagnoses and symptoms affect people’s lives more broadly. Furthermore, rehabilitation is a human rights imperative, which deserves the energetic attention enjoyed by other aspects of HIV treatment and care. In particular, the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is shining a long-overdue spotlight on the human rights imperatives associated with disability. For South Africa and other countries, proactively and meaningfully engaging rehabilitation in the HIV response will require major shifts on several fronts, including practice, education, policy and research. We argue that in settings where ART delivery is now widespread, HIV should be understood not only as a medical issue, but as a rehabilitation and disability concern. Whereas medicine adds years to life, it is rehabilitation that aims to add life to years.
Immunology for Clinicians: A ‘Trojan Horse’ Approach
Authors: Gray Clive M , Loubser Shayne , Kriel Carina , Mercer Monica
Published: June 2017

Immunology for Clinicians:

A ‘Trojan Horse’ Approach
TB/HIV integration at primary care level: A quantitative assessment at 3 clinics in Johannesburg, South Africa
Authors: Page-Shipp L , Voss de Lima Y , Clouse K , De Vos J , Evarts L , Bassett J , Sanne I , Van Rie A
Published: June 2017

Background. In 2004 the World Health Organization (WHO) released the Interim Policy on Collaborative TB/HIV activities. According to the policy, for people living with HIV (PLWH), activities include intensified case finding, isoniazid preventive therapy (IPT) and infection control. For TB patients, activities included HIV counselling and testing (HCT), prevention messages, and cotrimoxazole preventive therapy (CPT), care and support, and antiretroviral therapy (ART) for those with HIV-associated TB. While important progress has been made in implementation, targets of the WHO Global Plan to Stop TB have not been reached.

Objective. To quantify TB/HIV integration at 3 primary healthcare clinics in Johannesburg, South Africa.

Methods. Routinely collected TB and HIV data from the HCT register, TB ‘suspect’ register, TB treatment register, clinic files and HIV electronic database, collected over a 3-month period, were reviewed.

Results. Of 1 104 people receiving HCT: 306 (28%) were HIV-positive; a CD4 count was documented for 57%; and few received TB screening or IPT. In clinic encounters among PLWH, 921 (15%) had documented TB symptoms; only 10% were assessed by smear microscopy, and few asymptomatic PLWH were offered IPT. Infection control was poorly documented and implemented. HIV status was documented for 155 (75%) of the 208 TB patients; 90% were HIV-positive and 88% had a documented CD4 count. Provision of CPT and ART was poorly documented.

Conclusion. The coverage of most TB/HIV collaborative activities was below Global Plan targets. The lack of standardised recording tools and incomplete documentation impeded assessment at facility level and limited the accuracy of compiled data.
Persistent dizziness and recurrent syncope due to HIV-associated Addison’s disease: Case report from a resource-limited setting
Authors: Kibirige D , Ssekitoleko R , Mutebi E
Published: June 2017

Addison’s disease or primary adrenal insufficiency is a well-recognised fatal endocrine condition among HIV-infected patients. HIV infection is associated with adrenal gland destruction and profound disruption of the hypothalamic-pituitary adrenal axis. We describe a case of HIV-associated Addison’s disease in a 58-year-old newly diagnosed HIV-seropositive male patient, highlighting its occurrence in this era of HIV/AIDS pandemic.
Reflections on HIV care and ART – a view from Pietermaritzburg
Authors: Armstrong Caroline
Published: June 2017

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Management of cryptococcal meningitis in adults at Mthatha Hospital Complex, Eastern Cape, South Africa
Authors: Sogbanmu Olufunso Oladipupo , John Melanie-Anne Amanda , Lalloo Umesh
Published: June 2017

Background. Cryptoccocal meningitis (CM) remains prevalent in HIV-infected individuals across South Africa (SA). Early diagnosis and management, aided by the existing Southern African HIV Clinicians Society (SAHIVSoc) 2007 guidelines on management of CM, could reduce the mortality associated with this condition. Objective. To review the management of adult patients with CM and adherence to the SAHIVSoc 2007 guidelines in a district hospital.Methods. A retrospective chart review of patients admitted with CM from December 2011 to May 2012 was performed. The following key recommendations of the guidelines were evaluated: measurement of cerebrospinal fluid (CSF) opening pressure at the first lumbar puncture (LP), prescription of amphotericin B (AMB)/fluconazole therapy, intravenous prehydration preceding administration of AMB, monitoring of renal function and performance of serial LPs to manage raised intracranial pressure (ICP).Results. A total of 57 patient charts were reviewed, of which 40 (70%) were of females. The mean age (range) of the cohort was 36 (21 - 60) years. Fifty-two (91%) patients presented with headache. Confusion was recorded in 30 (53%) and vomiting in 26 (46%). The major signs observed were fever (n=29 (51%)) and neck stiffness (n=34 (60%)). Fifty-five (96%) patients were HIV-infected at presentation, with a median (range) CD4+ count of 77 (13 - 90) cells/µl. None of the patients had a CSF opening pressure measured at first LP. AMB was used as an induction agent in 51 (89%) patients, of whom 47 (92%) completed 2 weeks of AMB. Of these 51, only 20 (40%) were prehydrated and 10 (18%) had two repeat LPs performed 1 week apart. Renal function was monitored in only 27 (53%) of the patients receiving AMB. This was done at baseline and twice weekly, and was consistent with the guidelines. No abnormality in renal function was recorded in these cases during the study. The mortality rate was 30% in the first 10 days of admission.Conclusion. This chart review showed inadequate adherence to the recommendations of the 2007 SAHIVSoc guidelines in the majority of cases except for the use of AMB as a first-line antifungal agent. Control of ICP and monitoring for drug toxicity were not done as per guidelines and may impact on clinical care and outcome. Despite this, the early 30% mortality is comparable with published reports from other regions in SA, but is higher than in developed health systems.
Management of patients presenting with diarrhoea to a regional emergency department in KwaZulu-Natal: Call for clearer, more relevant guidance
Authors: Kudsk-Iversen Soren , Gilbert John Paul , Azarath Anneshree
Published: June 2017

Background. HIV is prevalent throughout South Africa, and diarrhoea is a common presentation to the emergency department (ED) among both HIV-infected and -uninfected individuals. Method. We audited the management of diarrhoea against standard guidelines in the ED of a regional hospital in KwaZulu-Natal. Patients presenting with diarrhoea as their chief complaint were eligible and data were collected prospectively. Results. A total of 72 patients were included: 58 (81%) of patients were HIV-positive with an average CD4+ count of 180 cells/µl. A total of 34 stool samples were sent for standard microscopy and culture (M&C), among which 26 were positive (76%). Forty-three patients (60%) received antibiotics, 15 of whom had positive stool M&C. In all cases, the final diagnosis was listed as acute gastroenteritis without further specification, and antibiotic use according to guidelines appeared inconsistent. Conclusion. Based on this audit, we suggest that current guidelines are not clear concerning management of acute diarrhoea in HIV-infected individuals, and that the lack of clear management strategies is likely to affect patient safety and increase antibiotic resistance.
Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa
Authors: Morsheimer M. M. , Dramowski A. , Rabie H. , Cotton M. F.
Published: June 2017

Background. Although subSaharan Africa faces the world’s largest paediatric HIV epidemic, only 1 in 4 children has access to combination antiretroviral therapy (ART). A decentralised approach to HIV care is advocated, but programmes in resource-limited settings encounter many challenges to community-initiated paediatric ART implementation. Methods.  A retrospective cohort analysis of 613 children receiving ART between 2004 and 2009 was performed in seven physician-run primary healthcare (PHC) clinics in Cape Town. Baseline characteristics, serial CD4+, viral load (VL) levels and status at study closure were collected. Results. Two subgroups were identified: children who were initiated on ART in a PHC clinic (n=343) and children who were down-referred from tertiary hospitals (n=270). The numbers of children initiated on ART in PHC increased sevenfold over the study period. Down-referred children were severely ill at ART initiation, with higher VLs, lower CD4+ counts and higher rates of tuberculosis co-infection (25.3% v. 16.9%; p=0.01). Median time to virological suppression was 29 weeks in PHC-ART initiates and 44 weeks in children down-referred (p<0.0001). Children down-referred to PHC either maintained or gained virological suppression. Longitudinal cohort analysis demonstrated sustained VL suppression >80%, high rates of immune reconstitution and low mortality.Conclusions. Increasing numbers of children are initiated on ART in PHC settings and achieve comparable immunological, virological and survival outcomes, suggesting successful decentralisation of paediatric HIV care. Down-referral of children with adherence-related virological failure may assist with attainment of virological suppression and sparing use of second-line medications.
Routine cranial computed tomography before lumbar puncture in HIV-positive adults presenting with seizures at Mitchells Plain Hospital, Cape Town
Authors: Moolla Salma , Rajkumar Ashmitha , De Vries Elma
Published: June 2017

Background: Current international guidelines recommend that a cranial computed tomography (CT) be performed on all HIV-positive patients presenting with new onset seizures, before a lumbar puncture (LP) is performed. In the South African setting, however,this delay could be life threatening. The present study sought to measure the number of cranial CTs that contraindicate an LP and to predict which clinical signs and symptoms are likely to pose an increased risk from LP.Methods: The study was performed at a district level hospital in Western Cape Province. Data were collected retrospectively from October 2013 to October 2014. Associations between categorical variables were analysed using Pearson’s chi-squared test. Generalised linear regression was used to estimate prevalence ratios.Results: One hundred out of 132 patients were studied. Brain shift contraindicated an LP in 5% of patients. Patients with brain shift presented with decreased level of consciousness, focal signs, headache and neck stiffness. Twenty-five per cent of patients had a space-occupying lesion (SOL) (defined as a discrete lesion that has a measurable volume) or cerebral oedema. Multivariate analysis showed a CD4 count <50 (p = 0.033) to be a statistically significant predictor of patients with SOL and cerebral oedema. Univariate analysis showed focal signs (p = 0.0001), neck stiffness (p = 0.05), vomiting (p = 0.018) and a Glascow Coma Scale (GCS) < 15 (p = 0.002) to be predictors of SOL and cerebral oedema.Conclusion: HIV-positive patients with seizures have a high prevalence of SOL and cerebral oedema but the majority of them are safe for LP. Doctors can use clinical parameters to determine which patients can undergo immediate LP.
Preventing mother-to-child transmission of HIV
Authors: McIntyre James , Gray Glenda
Published: June 2017

No abstract available.
A bizarre battle
Authors: Bekker Linda-Gail
Published: June 2017

No abstract available.
Classification of HIV disese in children - towards pragmatism?
Authors: Cotton Mark F
Published: June 2017

No abstract available.
Guidelines for the prevention, diagnosis and management of NRTI-hyperlactataemia and lactic acidosis
Authors: Office Editorial
Published: June 2017

No abstract available.
The role of stavudine in the South African public sector antiretroviral programme: Should the perfect be the enemy of the good?
Authors: Wood Robin
Published: June 2017

No abstract available.
Profile: HIV in North West province, South Africa
Authors: Variava E.
Published: June 2017

No abstract available.
Tribute - Penny Penhall
Authors: Martin Des
Published: June 2017

No abstract available.
From the Editor
Authors: Bekker Linda-Gail
Published: June 2017

No abstract available.
Special issue dedicated to Professor Deo Strümpfer
Authors: De Bruin G.P. , Crous Freddie
Published: June 2017

Dedicated to Professor Deo Strümpfer