bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution Function of Neutral Helium outside and inside the Heliopause
Authors: Kubiak M. A. , Bzowski M. , Sokół J. M.
Published: September 2019

Interaction of the solar wind with interstellar matter involves, among other processes, charge exchange between interstellar neutral atoms and plasma, which results in the creation of a secondary population of interstellar neutral (ISN) atoms. The secondary population of interstellar He was detected by Interstellar Boundary Explorer (IBEX), but interpretation of these measurements was mostly based on an approximation that the primary interstellar neutral population and the secondary population were non-interacting homogeneous Maxwell–Boltzmann functions in the outer heliosheath. We simulate the distribution function in the outer heliosheath and inside the heliopause using the “method of characteristics” with statistical weights obtained from solutions of the production and loss equations for the secondary atoms due to charge-exchange collisions in the outer heliosheath. We show that the two-Maxwellian approximation for the distribution function of neutral He is not a good approximation within the outer heliosheath but a reasonable one inside the termination shock. This is due to a strong selection effect: the He atoms able to penetrate inside the termination shock are a small, peculiar subset of the entire secondary He population. Nevertheless, the two-Maxwellian approximation reproduces the density distribution of ISN He inside the termination shock well and enables a realistic reproduction of the orientation of the plane defined by the Sun’s velocity vector through the local interstellar matter and the vector of the unperturbed interstellar magnetic field.
Desaturating SDO/AIA Observations of Solar Flaring Storms
Authors: Guastavino Sabrina , Piana Michele , Massone Anna Maria , Schwartz Richard , Benvenuto Federico
Published: September 2019

Image saturation has been an issue for several instruments in solar astronomy, mainly at EUV wavelengths. However, with the launch of the Atmospheric Imaging Assembly (AIA) as part of the payload of the Solar Dynamic Observatory image saturation has become a big data issue, involving around 105 frames of the impressive data set the telescope has been providing every year since 2010 February. This paper introduces a novel desaturation method that utilizes a sparsity constraint to solve the inverse scattering problem of determining the signal in the primary saturation region from the knowledge of the diffraction fringes produced by the instrument point-spread function. The method works without any need of a priori information on the image background and therefore can be applied even for desaturation of several consecutively deteriorated frames recorded during long-lasting intense solar storms. This peculiar methodological property could make this algorithm a possible tool for the realization of an automatic pipeline for the processing of the whole AIA data archive.
A Photometric and Spectroscopic Investigation of the DB White Dwarf Population Using SDSS and Gaia Data
Authors: Genest-Beaulieu C. , Bergeron P.
Published: September 2019

We present a comprehensive analysis of DB white dwarfs drawn from the Sloan Digital Sky Survey, based on model fits to ugriz photometry and medium-resolution spectroscopy from the Sloan Digital Sky Survey. We also take advantage of the exquisite trigonometric parallax measurements recently obtained by the Gaia mission. Using the so-called photometric and spectroscopic techniques, we measure the atmospheric and physical parameters of each object in our sample (T
eff,

,

, Ca/He, R, M), and compare the values obtained from both techniques in order to assess the precision and accuracy of each method. We then explore in great detail the surface gravity, stellar mass, and hydrogen abundance distributions of DB white dwarfs as a function of effective temperature. We present some clear evidence for a large population of unresolved double-degenerate binaries composed of DB+DB and even DB+DA white dwarfs. In the light of our results, we finally discuss the spectral evolution of DB white dwarfs, in particular the evolution of the DB-to-DA ratio as a function of T
eff, and we revisit the question of the origin of hydrogen in DBA white dwarfs.
SYNTHESYS+ Abridged Grant Proposal
Authors: Smith Vincent , Gorman Kristina , Addink Wouter , Arvanitidis Christos , Casino Ana , Dixey Katherine , Dröge Gabriele , Groom Quentin , Haston Elspeth , Hobern Donald , Knapp Sandra , Koureas Dimitrios , Livermore Laurence , Seberg Ole
Published: September 2019

European natural history collections are a critical infrastructure for meeting the most important challenge humans face over the next 30 years – creating a sustainable future for ourselves and the natural systems on which we depend – and for answering fundamental scientific questions about ecological, evolutionary, and geological processes. Since 2004 SYNTHESYS has been an essential instrument supporting this community, underpinning new ways to access and exploit collections, harmonising policy and providing significant new insights for thousands of researchers, while fostering the development of new approaches to face urgent societal challenges. SYNTHESYS+ is a fourth iteration of this programme, and represents a step change in the evolution of this community. For the first time SYNTHESYS+ brings together the European branches of the global natural science organisations (GBIF https://www.gbif.org/, TDWG https://www.tdwg.org/, GGBN http://www.ggbn.org/ggbn_portal/ and CETAF https://cetaf.org/) with an unprecedented number of collections, to integrate, innovate and internationalise our efforts within the global scientific collections community. Major new developments addressed by SYNTHESYS+ include the delivery of a new virtual access programme, providing digitisation on demand services to a significantly expanded user community; the construction of a European Loans and Visits System (ELViS) providing, for the first time, a unified gateway to accessing digital, physical and molecular collections; and a new data processing platform (the Specimen Data Refinery), applying cutting edge artificial intelligence to dramatically speed up the digital mobilisation of natural history collections. The activities of SYNTHESYS+ form a critical dependency for DiSSCo - the Distributed System of Scientific Collections (https://dissco.eu/), which is the European Research Infrastructure for natural science collections, under the ESFRI umbrella. DiSSCo will undertake the maintenance and sustainability of SYNTHESYS+ products at the end of the programme.
Approche cognitive du livre et des nouvelles technologies en orthophonie
Authors: Samier Rémi , Jacques Sylvie
Published: September 2019

Le livre est un outil intéressant pour développer les fonctions cognitives, le langage et faciliter les apprentissages scolaires. Évaluation, rééducation et compensation des troubles sont les trois usages principaux des nouvelles technologies en orthophonie. Pour la rééducation des fonctions exécutives, les nouvelles technologies offrent un bénéfice limité dans la vie quotidienne. Cependant, elles seraient plus efficaces si elles s’appuyaient sur trois principes : diversité, nouveauté et complexité, à l’instar du livre. Quoi qu’il en soit, les nouvelles technologies sont à valoriser pour la compensation des troubles. La métaphore des « neurones aimants » facilite la compréhension du circuit de la récompense par les enfants et les familles et favorise une gestion raisonnée des écrans.
L’accointance, le sens de l’accointance, et la nature de la perception
Authors: Dokic Jérôme
Published: September 2019

Si l’accointance est définie comme une relation mentale entre un sujet et un fragment de réalité, le sens de l’accointance est le sentiment pour le sujet d’être en rapport direct avec un fragment de réalité. Pour de nombreux philosophes, le sens de l’accointance fait partie de l’essence de la perception consciente : voir une montagne, par exemple, implique le sentiment d’être en rapport direct avec elle, de l’avoir « en chair et en os » sous les yeux, plutôt que de la viser à travers une représentation mentale indépendante. La thèse principale défendue dans cet essai est que le sens de l’accointance est indépendant et distinct de l’accointance elle-même. Plusieurs exemples présentés montrent que pour être véritablement accointé avec la réalité, il n’est ni nécessaire ni suffisant d’avoir le sentiment d’accointance. Le sens de l’accointance est mieux conçu comme une expérience métacognitive séparée de l’accointance. L’article examine enfin les conséquences de cette thèse pour la question de savoir si la perception implique ou repose sur une représentation mentale de ce qui est perçu.
La civilité est-elle réac ?
Authors: Gayet-Viaud Carole
Published: September 2019

La civilité est un concept qui fait aujourd’hui l’objet de polarisations très fortes, sur les plans à la fois disciplinaire et idéologique. Pour les uns, elle figure un éden perdu, pour les autres, un mot d’ordre piégé, l’instrument d’une lutte pour l’ordre, en soi réactionnaire. Cette situation appelle une analyse de type généalogique afin d’éclairer la façon dont cette opposition binaire s’est imposée. L’article montre comment le développement du problème public de l’incivilité en France à partir des années 1990 a contribué à structurer l’étude de la civilité et de l’incivilité comme deux domaines distincts, et à configurer les questions relatives à la civilité dans les termes d’une opposition idéologique dont la question de l’ordre est devenue l’enjeu central, plaçant la civilité du côté de la pensée réactionnaire. On arguera que la mise en œuvre d’une démarche d’enquête prenant pour objet les interactions civiles appelle à dépasser cette perspective binaire et à envisager la civilité comme une activité dynamique, visant à définir le juste réglage des conduites en public, où le rapport des conventions à un sens ordinaire du juste fait l’objet d’une attention critique et d’une enquête itérative, plutôt que d’une application ou d’un rejet aveugles.
La rêverie d’un bébé solidaire
Authors: Clerget Joël
Published: September 2019

Le bébé du rêve n’est pas celui de la réalité. Ce que nous désirons pour la vie d’un bébé ne relève pas d’une volonté pour un objet, mais d’un trajet accompli à ses côtés et avec lui.
Functional Outcomes and Reading Performance After Combined Implantation of a Small-Aperture Lens and a Segmental Refractive Bifocal Lens
Authors: Son Hyeck-Soo , Khoramnia Ramin , Yildirim Timur M. , Baur Isabella , Labuz Grzegorz , Auffarth Gerd U.
Published: September 2019

PURPOSE:

Clinical evaluation of the visual outcomes after implantation of a small-aperture extended depth of focus (EDOF) intraocular lens (IOL) and a segmental refractive bifocal lens.

METHODS:

In this prospective study, 13 patients with cataract received a small-aperture IC-8 IOL (AcuFocus, Irvine, CA) in one eye and a segmental-refractive Lentis Mplus LS-313 MF20 IOL (Oculentis, Berlin, Germany) in the fellow eye. The clinical examination included measurements of uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity. Additionally, a defocus curve was obtained from +2.00 to −5.00 diopters (D) and a Salzburg Reading Desk was used to assess the patients' reading acuity at intermediate and near distances. A halo and glare simulator was used to evaluate the postoperative perception of dysphotopsia.

RESULTS:

At 5 months postoperatively, the mean binocular visual results demonstrated UDVA, UIVA, and UNVA values of −0.04 ± 0.11, 0.00 ± 0.10, and 0.11 ± 0.08 logMAR, respectively. The binocular distance-corrected reading performance test also confirmed the improved visual function, with an intermediate reading acuity of 0.12 logMAR at 69.21 cm and a near reading acuity of 0.19 logMAR at 41.63 cm. The mean halo size was 32.54 ± 22.38, mean halo intensity was 34.46 ± 21.95, mean glare size was 9.00 ± 17.47, and mean glare intensity was 9.92 ± 16.84.

CONCLUSIONS:

The new concept of a combined implantation of a small-aperture IOL and a segmental-refractive bifocal lens showed good results in far and intermediate distances and functional results at near distance, while causing minimal photic phenomena.

[
J Refract Surg.
2019;35(9):551–558.]
Repeatability of Cornea and Sublayer Thickness Measurements Using Optical Coherence Tomography in Corneas of Anomalous Refractive Status
Authors: Lu Nan-Ji , Chen Ding , Cui Le-Le , Wang Lin , Chen Shi-Hao , Wang Qin-Mei
Published: September 2019

PURPOSE:

To assess the repeatability of epithelial, stromal, and total corneal thickness measurements with spectral-domain optical coherence tomography (SD-OCT; RTVue-XR; Optovue, Inc., Fremont, CA) in patients with myopia, keratoconus, and corneas after transepithelial photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and femtosecond laser–assisted in situ keratomileusis (FS-LASIK).

METHODS:

A total of 352 eyes of 352 patients (75 myopic, 68 post-transepithelial PRK, 61 post-SMILE, 75 post-FS-LASIK, 20 mild keratoconus, and 53 advanced keratoconus eyes) were included. The epithelial, stromal, and total corneal thickness were recorded from the pachymetric map in the following four zones: (1) central 2-mm region, (2) eight paracentral regions within 2- to 5-mm diameter, (3) eight midperipheral regions within 5- to 7-mm diameter, and (4) eight peripheral regions within 7- to 9-mm diameter. Three successive scans were performed to evaluate the repeatability.

RESULTS:

For all zones up to 9-mm diameter, the coefficient of variation (CoV) for epithelial thickness measurements ranged from 1.7% to 3.5% for myopia, 2.6% to 6.2% for post-transepithelial PRK, 2.3% to 4.7% for post-SMILE, 4.0% to 6.3% for post-FS-LASIK, 2.5% to 6.2% for mild keratoconus, and 3.5% to 8.0% for advanced keratoconus. The CoV for stromal and total thickness measurements ranged from 0.2% to 2.0% for myopia, 0.7% to 4.2% for post-transepithelial PRK, 0.3% to 2.4% for post-SMILE, 0.3% to 1.9% for post-FS-LASIK, 0.6% to 3.0% for mild keratoconus, and 1.0% to 5.9% for advanced keratoconus.

CONCLUSIONS:

RTVue-XR SD-OCT showed excellent repeatability when generating the pachymetric map in myopic eyes. Measurements, especially for epithelial thickness, were relatively more variable for corneas with keratoconus and those having undergone keratorefractive surgery.

[
J Refract Surg.
2019;35(9):600–605.]
Incidence and Risk Factors of Opaque Bubble Layer Formation According to Flap Thickness During 500-kHz FS-LASIK
Authors: Lim Dong Hui , Hyun Joo , Shin Eunhae , Ko Byung-woo , Chung Eui-Sang , Chung Tae-Young
Published: September 2019

PURPOSE:

To present the incidence, risk factors, and effect of opaque bubble layer (OBL) formation during flap creation in laser-assisted in situ keratomileusis (LASIK) with a 500-kHz femtosecond laser on visual performance.

METHODS:

In this retrospective study, preoperative characteristics (age, sex, keratometric value, spherical equivalent, and central corneal thickness) and intraoperative surgical factors (used energy, docking type, and flap thickness) were compared between eyes with and without OBL formation during flap creation. Possible risk factors for specific types of OBLs were analyzed.

RESULTS:

One hundred thirty-five eyes of 71 patients underwent LASIK, and OBL developed in 98 eyes (72.59%). In the univariate analysis, the greater than 80-µm flap group was associated with a lower OBL occurrence than the 80-µm flap group (
P
= .0424, odds ratio [OR] = 0.481) and hard docking was associated with increased OBL formation (
P
= .0001, OR = 6.859). In the multivariate analysis, hard docking was a risk factor for OBL development (
P
= .0003, OR = 6.329). In the subgroup analysis, hard docking had a marginal effect on OBL occurrence in the 80-µm flap group (
P
= .086, OR = 3.564), but it had a strong effect in the greater than 80-µm flap group (
P
= .0018, OR = 10.210).

CONCLUSIONS:

Hard docking is a risk factor for OBL development. However, hard docking had a small effect on OBL occurrence in the 80-µm flap group during LASIK. OBL formation did not affect visual performance.

[
J Refract Surg.
2019;35(9):583–589.]
Refractive and Visual Outcomes of SUPRACOR TENEO 317 LASIK for Presbyopia in Hyperopic Eyes: 24-Month Follow-up
Authors: Sánchez-González José-María , Alonso-Aliste Federico , Amián-Cordero Jonatan , Sánchez-González María Carmen , De-Hita-Cantalejo Concepción
Published: September 2019

PURPOSE:

To analyze the efficacy, safety, predictability, and stability in hyperopic presbyopic laser in situ keratomileusis (LASIK) surgeries with the TENEO 317 algorithm (Bausch & Lomb Technolas, Munich, Germany).

METHODS:

Eighty eyes from 40 patients who underwent hyperopic and presbyopic LASIK in this retrospective, observational, and longitudinal study were included. All patients had a 24-month follow-up. Excimer laser treatment was performed with TECNOLAS Perfect Vision GmbH TENEO 317 software version 1.25 (Bausch & Lomb) with the PROSCAN platform for the distance dominant eye and the SUPRACOR mild platform for the near dominant eye.

RESULTS:

Mean age was 53.90 ± 4.84 years (range: 42 to 66 years). Postoperative uncorrected distance visual acuity (UDVA) was 0.00 ± 0.04 (20/19.97) for the dominant eye and 0.14 ± 0.05 (20/27.65) for the non-dominant eye. Postoperative uncorrected near visual acuity was 0.51 ± 0.17 (J9) for the dominant eye and 0.09 ± 0.06 (J1.5) for the non-dominant eye, whereas 2.5% of non-dominant eyes lost two lines of corrected distance visual acuity. Half of non-dominant eyes lost one line, and 2.5% of dominant and non-dominant eyes changed 0.50 D or more between 3 and 24 months.

CONCLUSIONS:

PROSCAN surgery in the dominant eye and SUPRACOR surgery in the non-dominant eye using the TENEO 317 algorithm demonstrated that the hyperopic presbyopic excimer laser surgery technique resulted in acceptable and stable outcomes after 24 months of follow-up.

[
J Refract Surg.
2019;35(9):591–598.]
IL-10 Has Differential Effects on the Innate and Adaptive Immune Systems of Septic Patients
Authors: Mazer Monty , Unsinger Jaqueline , Drewry Anne , Walton Andrew , Osborne Dale , Blood Theresa , Hotchkiss Richard , Remy Kenneth E.
Published: September 2019

Sepsis, a disease of divergent pro- and anti-inflammatory–mediated pathways, has a high prevalence of morbidity and mortality, yet an understanding of potential unifying mediators between these pathways that may improve clinical outcomes is largely unclear. IL-10 has classically been designated an immunosuppressive cytokine, although recent data suggest that under certain conditions IL-10 can be immune stimulatory. We sought to further investigate the effect of IL-10 on innate and adaptive immunity in an in vitro human observational cohort study in patients with sepsis via modulation of IL-10 on IFN-γ production by T cells and TNF-α production and HLA-DR expression by monocytes. These results were compared with critically ill nonseptic patients and healthy volunteers. ELISpot analysis was performed using PBMC fraction from patient whole-blood samples. Finally, to provide additional potential clinical relevance, we examined the effect of IL-10 on T cell IFN-γ production in an in vivo cecal ligation and puncture model of sepsis using C57 black/J6 female mice. We found that inhibition of IL-10 significantly increased both production of T cell IFN-γ and monocyte TNF-α, whereas addition of IL-10 increased T cell IFN-γ production but decreased monocyte production of TNF-α and HLA-DR expression. There was no significant effect of IL-10 on control cohorts. IL-10–treated septic mice demonstrated increased IFN-γ production in splenocytes. Thus, IL-10 demonstrates both pro- and anti-inflammatory effects in the septic microenvironment, which is likely cell and context dependent. Further elucidation of relevant signaling pathways may direct future therapeutic targets.
Assisted living in rural areas: aging in blurred landscapes
Authors: Blix Bodil H. , Hamran Torunn
Published: September 2019

Here, we explore the experiences and practices of care in the context of assisted living facilities (ALFs) in rural areas from the perspectives of family members, health care professionals, and senior citizen interest group representatives. Specifically, we focus on the potential for ALFs to safeguard and unify the health care policy ambitions of equity, quality, and aging in place. Focus group interviews with health care professionals and interest group representatives and individual interviews with family members were conducted in largely rural Norwegian municipalities. Providing high-quality health care services in people’s homes remains challenging, particularly in rural areas. ALFs have been introduced as a compromise, a home away from home. In rural areas, ALFs are typically localized in community centers. ALFs are neither homes nor nursing homes, and residents possess varying and changing care needs. Several parties experience challenges with respect to safety, evolving care needs, and responsibilities. Moreover, the service allocation and user payment systems may undermine equity. This study indicates that health care authorities should evaluate whether prioritizing assisted living is still suitable for the aging population in rural areas and beyond.
There’s just huge anxiety: ontological security, moral panic, and the decline in young people’s mental health and well-being in the UK
Authors: Bell Jo , Reid Marie , Dyson Judith , Schlosser Annette , Alexander Tim
Published: September 2019

This study aims to critically discuss factors associated with a recent dramatic rise in recorded mental health issues amongst UK youth. It draws from interviews and focus groups undertaken with young people, parents and professionals. We offer valuable new insights into significant issues affecting young people’s mental health and well-being that are grounded in their lived experiences and in those who care for and work with them. By means of a thematic analysis of the data, we identified an increase in anxiety related to: future orientation, social media use, education, austerity, and normalization of mental distress and self-harm. We apply the notion of ontological security in our interpretation of how socio-cultural and political changes have increased anxiety amongst young people and consequent uncertainty about the self, the world and the future, leading to mental health problems. There are also problems conceptualizing and managing adolescent mental health, including increased awareness, increased acceptance of these problems, and stigmatisation. We relate this to the tendency for moral panic and widespread dissemination of problems in a risk society. In our conclusion, we highlight implications for future research, policy and practice.
COLISTIN: adult and paediatric guideline for South Africa, 2016
Authors: Labuschagne Quinten , Schellack Natalie , Gous Andries , Bronkhorst Elmien , Schellack Gustav , Van Tonder Lindie , Truter Archele , Smith Caroline , Lancaster Ruth , Kolman Sonya
Published: September 2019

This document was created to serve as a guideline for colistin prescribing in South Africa. Antimicrobial resistance is threatening the effective prevention and treatment of a wide variety of infections, especially those that are caused by multi-drug-resistant (MDR) gram-negative bacteria. Colistin is typically used as salvage therapy, or last-line treatment, for MDR gram-negative infections. The dosing regimen should be optimised to be therapeutic and halt the emergence of resistance, whilst minimizing toxicity. This document provides evidence-based recommendations for adult and paediatric dosing, dosing in renal impairment, and the use of combination therapy to increase synergistic effects, as well as guidelines on the reconstitution and administration of colistin. This guideline is specifically aimed at healthcare workers who routinely treat patients with MDR gram-negative infections, especially in the intensive care setting.
Clinico-epidemiological spectrum of melioidosis: a 2-year prospective study in the western coastal region of India
Authors: Chandrakar Sagar , Dias Meena
Published: September 2019

Objective: To determine the geographical epidemiology, clinical presentations and risk factors associated with melioidosis.Methods: A total of 28 confirmed cultures of Burkholderia pseudomallei were isolated and prospectively analysed with respect to clinico-demographic factors.Results: Age groups ranged from neonate to 84 years of age. Five children were less than 12 years of age. There was a male predominance of 71.4%. There was a crude mortality of 25%; all deaths were due to septic shock, 42.8% of which occurred within 48 hours of admission. A strong linear association (p = 0.01) was found between intensity of rainfall and presentation of cases. Proportion of cases and mortality were greater among those with occupational or recreational exposure to soil (75%). Pneumonia (32.1%) was the most frequent primary clinical presentation and diabetes mellitus (64.3%) constituted a major risk factor for both development and death due to melioidosis. Higher occurrence of mortality was noted among patients with chronic kidney disease (CKD) than others (Fischer’s exact test p = 0.04). One case of recurrence was noted.Conclusion: Melioidosis is quite prevalent in the western coastal region of India and is strongly associated with intensity of rainfall. There is increased risk among diabetics and to those who are exposed to soil and surface water. Melioidotic lymphadenopathy may mimic tuberculosis, hence should be considered as a differential diagnosis. Patients with bacteraemia have a poorer prognosis; and, septic shock relates to imminent death.
Retrospective comparison of cytological and histological bone marrow morphology in adult antiretroviral-naïve and antiretroviral experienced human immunodeficiency virus-infected patients with peripheral blood cytopaenias
Authors: Naidoo Suraya , Naicker Vincent L.
Published: September 2019

Background: A cohort of human immunodeficiency virus (HIV)-positive patients presenting to a quaternary hospital in KwaZuluNatal, South Africa over a period of one year was identified and morphological analyses of their bone marrow aspirates and trephine biopsies (BMAT) undertaken.Aim: To compare and contrast the bone marrow morphological features of antiretroviral (ARV)-naïve and ARV-experienced HIV-positive population with cytopaenias; correlate the findings with CD4 counts; and, draw conclusions on whether ARV are associated with specific bone marrow (BM) findings.Method: Aspirate and trephine biopsy examinations to assess dysplasia of cell lineages, architectural changes, granulomas or infiltrates were performed by light microscopy.Results: 74 BMAT were examined, of which 24 were from the ARV-naïve cohort and 50 from ARV-treated cohort. Within granulomas, higher rates of marrow infiltration by acid-fast bacilli was present in the ARV-naïve cohort than the ARV-experienced cohort (6/10 (60%) versus 9/26 (35%), respectively). Higher rates of pure red cell aplasia (PRCA) were detected in the ARV-experienced than the ARV-naive cohort (14% versus 4%, respectively). No difference was seen in morphological features and overall dysplasia rates (70% and 71% of ARV-naïve and ARV-experienced cohort, respectively). At CD4 200 cells/ul, higher rates of dysplasia were seen in the ARV-naïve cohort (3/3 (100%) than in the ARV-experienced cohort (13/20 (65%)).Conclusion: Similar dysplasia rates and morphological features in both cohorts suggest ARVs do not cause myelodysplasia. BM tuberculosis is more frequently detected in granulomas of ARV-naïve than ARV-experienced samples. ARVs are implicated in causation of PRCA.
Global emergence of a multi-drug resistant fungal pathogen, Candida auris
Authors: Britz Erika , Govender Nelesh P.
Published: September 2019

No abstract available.
Disseminated fungal infection in an HIV-infected patient due to Aureobasidium pullulans
Authors: Van Hougenhouck-Tulleken Wesley G. , Mathole Garrison , Karstaedt Alan , Govind Nimmisha , Moodley Magendhree , Seetharam Sharona , Govender Nelesh P. , Menezes Colin N.
Published: September 2019

In South Africa, novel fungal pathogens have emerged as an important cause of disease in HIV-infected individuals. The clinical presentation is characteristically prolonged, insidious and the diagnosis elusive, often being made post mortem. We report an HIV-infected individual with a systemic mycosis due to Aureobasidium pullulans, a ubiquitous dematiaceous mould which has not been described in HIV-infected individuals.
Knowledge and perceptions of antimicrobial stewardship concepts among final year pharmacy students in pharmacy schools across South Africa
Authors: Burger Marisa , Fourie Jaco , Loots Devin , Mnisi Tercia , Schellack Natalie , Bezuidenhout Selente , Meyer Johanna C.
Published: September 2019

Background: Antimicrobial stewardship is currently not mandatory as part of the undergraduate training of pharmacists. Identifying gaps in knowledge and a better understanding of pharmacy students’ perceptions about antimicrobial stewardship could assist in recommendations for appropriate changes to the pharmacy degree curricula that may lead to more appropriate use of antimicrobials, within the multi-disciplinary team.Methods: A descriptive quantitative study with a survey design was conducted at the eight universities offering the pharmacy degree in South Africa. An electronic questionnaire with four main categories on antimicrobial stewardship was administered to final (fourth) year pharmacy students (June–August 2015).Results: An overall response rate of 26.6% (n = 260) was obtained from 978 students, despite a weekly reminder. Most of the respondents were familiar with antimicrobial stewardship programmes in South Africa (71.9%), and claimed to know what antimicrobial stewardship is (83.5%) with significant differences between the universities (p 0.001). Only 37.7% of the respondents recalled having had formal training on antimicrobial stewardship, with responses from the eight universities differing significantly (p 0.001). However, almost all respondents (98.5%) felt that a strong knowledge of antimicrobials was important for their future career, with 90.0% indicating that they would like more training on antimicrobial stewardship at undergraduate level.Conclusion: There were significant differences between the eight universities with regards to undergraduate education on antimicrobial stewardship. In order to help prevent antimicrobial resistance, efforts should be made to introduce concepts of antimicrobial stewardship into the undergraduate pharmacy curricula to promote better use of antimicrobials and prevent antimicrobial resistance.
Review: Building and Evaluating Research Capacity in Healthcare Systems: Case Studies and Innovative Models
Authors: Naidoo Shan
Published: September 2019

No abstract available.
Prevention is better than cure!
Authors: Naidoo Shan
Published: September 2019

No abstract available.
Clinical Sciences and Therapeutics for health
Authors: Neophytou Natalia , Aginsky Kerith , Benjamin Natalie
Published: September 2019

No abstract availabe.
Pathological vestibular symptoms presenting in a group of adults with HIV/AIDS in Johannesburg, South Africa
Authors: Khoza-Shangase Katijah , Van Rie Kayla J.
Published: September 2019

Aim: The current study aimed to explore the pathological vestibular symptoms presenting in a group of adults with HIV/AIDS in Johannesburg, South Africa.Design: A quantitative non-experimental research design was adopted where data was collected by means of a questionnaire with close-ended questions on 96 participants who were recruited from a teaching hospital’s HIV/AIDS research unit.Analysis: Data were analysed through descriptive statistics.Results: Findings from the current study revealed that 17% of the sample studied presented with an occurrence of pathological vestibular symptoms. The most prominently reported pathological vestibular symptoms found were vertigo, dizziness, lightheadedness, unsteadiness and headaches. Of the participants experiencing vestibular symptoms, 69% reported experiencing co-occurring audiological symptoms. Collectively, these symptoms were found to have a significant effect on the participants’ quality of life and their ability to work. Interestingly, however, current findings revealed that only 31% of the participants experiencing pathological vestibular symptoms had reported these symptoms to medical professionals.
HIV transmission in twin pregnancy: Maternal and perinatal outcomes
Authors: Makunyane L. L. , Moodley J. , Titus M. J.
Published: September 2019

Background: Despite over two decades of studies of mother-to-child transmission (MTCT) of HIV, very little data is available on HIV transmission in twin pregnancies in Africa.Objective: To determine transmission rates of the HIV virus between twins and the maternal and perinatal outcomes in HIV positive twin pregnancies.Methods: An audit involving 186 sets of twin pregnancies delivered at two hospitals in KwaZulu-Natal, South Africa was conducted over a one year period. Relevant data included maternal age, parity, obstetric history, foetal presentation, gestational age at delivery, Apgar scores, birth weight and pregnancy complications.Results: Of 9521 deliveries, 186 (1.95%) women were identified with a twin pregnancy; 80 (43%) of these mothers were HIV infected. One twin was HIV infected giving an incidence of 0.9%. The infected twin was the first-born twin (or twin 1) and was delivered by Caesarean delivery. Based on mode of delivery, there was no transmission for twin 1 or twin 2 via vaginal delivery, but a 1.4% transmission for twin 1 and 0% for twin 2 following Caesarean delivery.Conclusion: Twin pregnancies are at low risk of MTCT of HIV provided the mother is on highly active antiretroviral therapy (HAART) or has taken effective antiretroviral (ARV) treatment (dual therapy) in the antenatal period.
Human immunodeficiency virus-related Epstein-Barr virus-associated smooth muscle tumours: South African experience from Chris Hani Baragwanath Academic Hospital
Authors: Pather Sugeshnee , Wainwright Rosalind D. , Sahid Faieza , Mashele Thembi , Van den Berg Eunice J.
Published: September 2019

Background: Despite the rampant human immunodeficiency (HIV) epidemic in Africa, there is a paucity of published data of HIV-related Epstein-Barr virus-associated smooth muscle tumours (EBV-SMT) from Africa.Methods: We embarked on retrospective documentation of the clinicopathological features of confirmed HIV-related EBV-SMT over a 5-year time frame at the largest hospital in Africa. All haematoxylin and eosin stained tissue sections, immunohistochemistry and EBV in situ hybridisation (ISH) investigations were reviewed in conjunction with clinical data.Results: Fourteen (n = 14) EBV-SMT were confirmed in 13 patients (age range: 10–53 years). Five paediatric patients and a predominance of females (70%) were evident in this series. All patients were HIV seropositive and CD4 counts ranged from 1 to 1331 cells/ul (median 355 cells/ul; mean 442 cells/ul). Tumour-associated pain was a common symptom in the paediatric age group, while neurological symptoms were frequent in the adults due to paraspinal cervicothoracic involvement. Unusual topography, multifocality (n = 5) and smooth muscle morphology in association with round cell features (n = 3) were evident. Immunoexpression of desmin (n = 12), SMA (n = 12) and h-Caldesmon (n = 8) were consistent findings and positive EBV ISH nuclear signaling was demonstrated within all of these tumours. Treatment included antiretroviral therapy, surgical resection, radiation and/or palliative therapy.Conclusion: HIV-associated EBV-SMT are rare tumours that may develop in paediatric or adult patients. A female predominance and multifocal topographic involvement may be evident. AIDS-related co-morbidities are likely to contribute to mortality; and, when these tumours occur in paraspinal regions, debilitating neurological morbidity may manifest.
Neonatal sepsis in a Nigerian Tertiary Hospital: Clinical features, clinical outcome, aetiology and antibiotic susceptibility pattern
Authors: Arowosegbe Adediwura O. , Ojo David A. , Dedeke Iyabode O. , Shittu Olufunke B. , Akingbade Olusola A.
Published: September 2019

Background:Neonatal sepsis is a significant cause of neonatal mortality in developing countries. The aetiological agents and their antimicrobial susceptibility patterns are dynamic.Objectives: This study determined clinical features, aetiology, antimicrobial susceptibility and clinical outcome of neonatal sepsis in a Nigerian Tertiary Hospital.Methods: Neonates undergoing sepsis evaluation at a Nigerian Tertiary Hospital were included in the study. Demographic and clinical information were obtained using standard questionnaires. Blood samples were cultured on MacConkey, Blood and Chocolate agar. Isolated bacteria were identified based on morphology, Gram stain appearance and standard commercially prepared biochemical tests. Antimicrobial susceptibility testing was performed on Mueller-Hinton agar using the Kirby-Bauer method.Results: Eighty-five of the 180 neonates admitted during the study period were recruited. Fifty-five neonates presented with early-onset sepsis and 30 with late-onset sepsis. Culture-proven sepsis was detected in 19 (22.4%) neonates. The incidence of culture-proven sepsis in the hospital was 2.8/100 live-births. The most common clinical feature at presentation was respiratory distress. Gram-negative bacteria accounted for 78.9 percent of all isolates and were the only organisms encountered in earlyonset sepsis. Isolated pathogens were predominantly Klebsiella spp (31.6%), Enterobacter spp (21.1%) and coagulase-negative Staphylococci (15.8%). The isolates were most sensitive to ofloxacin. Gram-negative bacteria showed high resistance to cefuroxime and ampicillin. The case-fatality rate was 26%.Conclusion: Gram-negative bacilli, especially Klebsiella spp, was predominant. Neonatal sepsis persists as a cause of mortality in this region. Regular antimicrobial surveillance for empirical treatment remains an important component of neonatal care.
South African guideline for the management of community-acquired pneumonia in adults
Authors: Boyles Tom H. , Brink Adrian , Calligaro Greg L. , Cohen Cheryl , Dheda Keertan , Maartens Gary , Richards Guy A. , Society South African Thoracic Society, Federati
Published: September 2019

No abstract available.
Antimicrobial susceptibility of Mycoplasma genitalium isolates from Pretoria, South Africa in 2012 and 2016
Authors: Le Roux Marie C. , Mafunise Maanda , De Villiers Barbara E. , Ditsele Ramalau M.
Published: September 2019

Background: Mycoplasma genitalium is a sexually transmitted pathogen associated with non-gonococcal urethritis and cervicitis. Azithromycin regimens have been considered first-line treatment for M. genitalium infections, with fluoroquinolone regimens effective as second-line treatments. However, the proportion of M. genitalium harbouring macrolide or fluoroquinolone resistance-associated mutations has been increasing worldwide. This study was done to compare the genotypic macrolide and fluoroquinolone resistance of M. genitalium strains obtained from women attending a termination of pregnancy clinic five years apart.Methods: M. genitalium was detected by PCR in vaginal swab samples from 100 and 104 termination of pregnancy attendees at a tertiary hospital in Pretoria, South Africa during 2012 and 2016 respectively. Genes associated with macrolide and fluoroquinolone resistance in the M. genitalium isolates were sequenced and analysed.Results: The prevalence of M. genitalium was 6.0% (6/100) in 2012 and 7.7% (8/104) in 2016. No resistance-associated mutations were seen in the 2012 isolates. Among the 2016 M. genitalium isolates, two (25%) harboured a macrolide-associated resistance mutation and one (12.5%) a fluoroquinolone resistance-associated mutation in the parC gene.Conclusions: There is an increase in macrolide and fluoroquinolone resistance among local M. genitalium strains. This highlights the need for improved surveillance.
HIV-1 RNA testing of pooled dried blood spots is feasible to diagnose acute HIV infection in resource limited settings
Authors: Dowling Wentzel , Veldsman Kirsten , Katusiime Mary G. , Maritz Jean , Bock Peter , Meehan Sue-Ann , Van Schalkwyk Marije , Cotton Mark F. , Preiser Wolfgang , Van Zyl Gert U.
Published: September 2019

Objectives:Rapid human immunodeficiency virus (HIV) antibody tests, routinely used for diagnosis in adults and older children in resource-limited settings (RLS), do not detect early HIV infections prior to seroconversion or when antibody levels are still low. Nucleic acid amplification to detect HIV-1 RNA is the most sensitive method for acute HIV infection diagnosis, but is costly. We therefore investigated HIV- 1 RNA testing of pooled dried blood spots (DBS) to diagnose acute HIV infection.Design:Laboratory-based investigation.Methods:DBS were collected from HIV-1 Voluntary Counselling and Testing (HVCT) clients who tested negative on the Advanced QualityTM HIV antibody rapid test. DBS samples from five participants were pooled and tested on the COBAS AmpliPrep/COBAS TaqMan HIV-1 (CAP/CTM) Test v2. Individual DBS were tested when pools tested positive ( 200 RNA copies/ml). Acute infection was confirmed by HIV viral load testing, two fourth-generation HIV serological assays, and Geenius™ HIV 1/2 Assay for antibody band identification.Results:Of 482 participants who were tested, one (0.2%) had acute. HIV infection: Fourth generation serology was low-level positive, the plasma HIV viral load was 15 929 HIV-1 RNA copies/ml, gp160 and gp41 antibody bands were positive and the p31 band was negative, indicating a Fiebig Stage 5 infection.Conclusions: Pooled DBS HIV-1 RNA testing is efficient compared to individual testing for acute HIV infection diagnosis. Early identification of participants with acute HIV infection facilitates immediate initiation of antiretroviral therapy to improve immune recovery and prevent transmission to others.
Prevalence and determinants of congenital cytomegalovirus infection at a rural South African central hospital in the Eastern Cape
Authors: Tshabalala Donald , Newman Howard , Businge Charles , Mabunda Sikhumbuzo A. , Kemp Waldette , Beja Pakama
Published: September 2019

Background: The Nelson Mandela Academic Hospital (NMAH) in Mthatha, Eastern Cape, is a rural central hospital, serving one of the poorest districts in South Africa. The prevalence of and risk factors for congenital cytomegalovirus (CMV) in this area are not known. The aim was to evaluate the prevalence of congenital CMV and associated risk factors for babies born at NMAH.Methods: This was a cross-sectional study to determine the prevalence of congenital CMV infection among babies born at Nelson Mandela Academic Hospital. Mother–baby pairs delivered consecutively from Monday to Friday, who gave informed consent, were included. Demographic information was collected on a questionnaire. All babies were tested for congenital CMV using a saliva swab PCR within the first week of life.Results: A total of 302 births were assessed. Congenital CMV was prevalent in 18 births (5.96%; 95% CI 3.29–8.63) and had an equal prevalence between HIV-exposed and HIV-unexposed newborns (prevalence ratio [PR] = 1.00; 95% CI 0.94–1.06; p = 0.869).Conclusions: The prevalence of congenital CMV of 5.96% is similar to findings from other resource-limited settings. There was no significant association between maternal HIV status and congenital CMV. With the prevalence of congenital CMV being as high as it is in the studied setting, clinicians are advised to have a high index of suspicion, especially when mothers are CMV seropositive.
Epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and comparison of the phenotypic versus genotypic screening tests for the detection of carbapenemases at a tertiary level, academic hospital in Johannesburg, South Africa
Authors: Thomas Teena S. M. , Duse Adriano G.
Published: September 2019

Background: Carbapenem-resistant Enterobacteriaceae (CRE) cause significant infections and pose a threat to the viability of available antibiotics. Understanding the epidemiology of these infections will assist in guiding appropriate treatment and infection prevention and control (IPC) practices in an institution. In addition, the phenotypic carbapenemase-producing Enterobacteriaceae (CPE) screening tests are widely used in South Africa. However, there is no published literature on their performance against PCR in that setting. Therefore, CRE epidemiology and performance of the Modified Hodge with Imipenem and Imipenem + EDTA combined disk tests (CDT) was evaluated at a tertiary academic hospital in Johannesburg.Method: A retrospective collection of data was performed. Data from January 2015 to December 2016 of all clinical isolates that were CRE OR carbapenem-susceptible Enterobacteriaceae with at least one positive CPE screening test were collected. Information collected included the ward areas from which samples were sent, specimen type that cultured CRE, CRE identification and carbapenem MIC results, phenotypic and genotypic CPE results.Results: Certain ward areas recurred as predominant areas with CRE infection in the two-year period. The prominent sample types that cultured CRE, the predominant Enterobacteriaceae species and carbapenemases identified corresponded with national surveillance data. The predominant carbapenemase type and level of carbapenem resistance conferred changed within one year. The Hodge test performed poorly for carbapenemase detection. The CDT detected metallo-β-lactamases adequately.Conclusion: In this study, the use of the MHT to screen for CPEs performed poorly. Continued surveillance will (i) lead to an understanding of the patient population (including infection type) affected, (ii) detect changes in the carbapenemase profiles, and (iii) inform infection prevention and control and appropriate clinical management.
Patients’ knowledge, attitudes and practices regarding antibiotic use at a regional hospital in KwaZulu-Natal, South Africa 2017
Authors: Ramchurren K. , Balakrishna Y. , Mahomed S.
Published: September 2019

Background: Antibiotic resistance is a major public-health problem globally and inappropriate antibiotic use is being increasingly recognised as the main force driving this resistance. Communities can contribute to the reduction of antibiotic resistance by using antibiotics appropriately and as prescribed. The purpose of this study was to assess the knowledge, attitudes and practices of patients regarding antibiotic use at a regional hospital in South Africa.Method: An observational analytic, cross-sectional study was conducted at Prince Mshiyeni Memorial Hospital between May and June 2017. A validated questionnaire consisting of closed-ended questions was administered to outpatients. Patients’ responses were scored and categorised as poor or good for knowledge, attitude and practice.Results: A total of 386 patients were interviewed. Only 205 (53%) patients had a good level of knowledge. Although 270 (70%) patients knew that antibiotics are indicated for the treatment of bacterial infections, 211 (55%) patients incorrectly thought that antibiotics are also used to treat viral infections. Only 168 (44%) patients were aware of the resistance associated with overusing antibiotics. With regard to patients’ attitudes, 164 (42%) patients believed that taking antibiotics for the common cold helped them to recover faster and 178 (46%) patients expected the doctor to prescribe more than one antibiotic for a severe cold. Overall, 157 patients (40%) reported having shared antibiotics with friends or family. Patients with good knowledge were six times more likely to have good antibiotic practices (OR 5.8; 95% CI 0.3–10.6; p 0.001).Conclusion: A well-planned education programme for the public should be undertaken to improve the knowledge and uses of antibiotics among patients.