Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi's sarcoma in five countries across sub-Saharan Africa.

BACKGROUND Survival after diagnosis is a fundamental concern in cancer epidemiology. In resource-rich settings, ambient clinical databases, municipal data and cancer registries make survival estimation in real-world populations relatively straightforward. In resource-poor settings, given the deficiencies in a variety of health-related data systems, it is less clear how well we can determine cancer survival from ambient data. METHODS We addressed this issue in sub-Saharan Africa for Kaposi's sarcoma (KS), a cancer for which incidence has exploded with the HIV epidemic but for which survival in the region may be changing with the recent advent of antiretroviral therapy (ART). From 33 primary care HIV Clinics in Kenya, Uganda, Malawi, Nigeria and Cameroon participating in the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortia in 2009-2012, we identified 1328 adults with newly diagnosed KS. Patients were evaluated from KS diagnosis until death, transfer to another facility or database closure. RESULTS Nominally, 22% of patients were estimated to be dead by 2 years, but this estimate was clouded by 45% cumulative lost to follow-up with unknown vital status by 2 years. After adjustment for site and CD4 count, age <30 years and male sex were independently associated with becoming lost. CONCLUSIONS In this community-based sample of patients diagnosed with KS in sub-Saharan Africa, almost half became lost to follow-up by 2 years. This precluded accurate estimation of survival. Until we either generally strengthen data systems or implement cancer-specific enhancements (e.g., tracking of the lost) in the region, insights from cancer epidemiology will be limited.

Hepatitis C in HIV-infected individuals: a systematic review and meta-analysis of estimated prevalence in Africa.

INTRODUCTION Although hepatitis C virus (HCV) screening is recommended for all HIV-infected patients initiating antiretroviral therapy, data on epidemiologic characteristics of HCV infection in resource-limited settings are scarce. METHODS We searched PubMed and EMBASE for studies assessing the prevalence of HCV infection among HIV-infected individuals in Africa and extracted data on laboratory methods used. Prevalence estimates from individual studies were combined for each country using random-effects meta-analysis. The importance of study design, population and setting as well as type of test (anti-HCV antibody tests and polymerase chain reactions) was examined with meta-regression. RESULTS Three randomized controlled trials, 28 cohort studies and 121 cross-sectional analyses with 108,180 HIV-infected individuals from 35 countries were included. The majority of data came from outpatient populations (55%), followed by blood donors (15%) and pregnant women (14%). Based on estimates from 159 study populations, anti-HCV positivity prevalence ranged between 3.3% (95% confidence interval (CI) 1.8-4.7) in Southern Africa and 42.3% (95% CI 4.1-80.5) in North Africa. Study design, type of setting and age distribution did not influence this prevalence significantly. The prevalence of replicating HCV infection, estimated from data of 29 cohorts, was 2.0% (95% CI 1.5-2.6). Ten studies from nine countries reported the HCV genotype of 74 samples, 53% were genotype 1, 24% genotype 2, 14% genotype 4 and 9% genotypes 3, 5 or 6. CONCLUSIONS The prevalence of anti-HCV antibodies is high in HIV-infected patients in Africa, but replicating HCV infection is rare and varies widely across countries.

Chemical composition of iron-manganese and phosphate rocks from aseismic ridges of the Indian Ocean and from the continental slope of the Southeast Africa

Study of chemical composition of 26 samples collected at depths from 400 to 1400 m on vertex surfaces of the Southeast Indian Ridge, Mascarene Ridge, Madagascar Ridge, and Mozambique Ridge, as well as on the upper part of the Southeast Africa continental slope showed that the samples represent three groups of rocks: 1) low phosphate or phosphate-free ferromanganese rocks, 2) phosphate ferromanganese rocks 3) phosphorites and phosphatized limestones.

Benthic foraminiferal d18O and Mg/Ca studies of sediment cores off tropical NW Africa

Benthic foraminiferal d18O and Mg/Ca of sediment cores off tropical NW Africa are used to study the properties of Atlantic central waters during the Last Glacial Maximum (LGM) and Heinrich Stadial 1 (HS1). We combined our core top data with published results to develop a new Mg/Ca-temperature calibration for Planulina ariminensis, which shows a Mg/Ca-temperature sensitivity of 0.19 mmol/mol per °C. Estimates of the LGM and HS1 thermocline temperatures are comparable to the present-day values between 200 and 400 m water depth, but were 1.2-1.5°C warmer at 550-570 m depth. The HS1 thermocline waters (200-570 m depth) did not show any warming relative to the LGM. This is in contrast to previous climate model studies, which concluded that tropical Atlantic thermocline waters warmed significantly when Atlantic meridional overturning circulation was reduced. However, our results suggest that thermocline temperatures of the northeastern tropical Atlantic show no pronounced sensitivity to changes in the thermohaline circulation during glacial periods. In contrast, we find a significant increase in thermocline-water salinity during the LGM (200-550 m depth) and HS1 (200-400 m depth) with respect to the present-day, which we relate to changes in the wind-driven circulation. We infer that the LGM thermocline (200-550 m depth) and the HS1 upper thermocline (200-400 m depth) in the northeastern tropical Atlantic was ventilated by surface waters from the North Atlantic rather than the southern-sourced waters. This suggests that the frontal zone between the modern South Atlantic and North Atlantic Central Waters was probably shifted southward during the LGM and HS1.

Standardized rainfall indices for the West and Central Sahel, and the Guinea Coast

For years, various indices of seasonal West African precipitation have served as useful predictors of the overall tropical cyclone activity in the Atlantic Ocean. Since the mid-1990s, the correlation unexpectedly deteriorated. In the present study, statistical techniques are developed to describe the nonstationary nature of the correlations between annual measures of Atlantic tropical cyclone activity and three selected West African precipitation indices (namely, western Sahelian precipitation in June-September, central Sahelian precipitation in June-September, and Guinean coastal precipitation in the preceding year's August-November period). The correlations between these parameters are found to vary over the period from 1921 to 2007 on a range of time scales. Additionally, considerable year-to-year variability in the strength of these correlations is documented by selecting subsamples of years with respect to various meteorological factors. Broadly, in years when the environment in the main development region is generally favorable for enhanced tropical cyclogenesis (e.g., when sea surface temperatures are high, when there is relatively little wind shear through the depth of the troposphere, or when the relative vorticity in the midtroposphere is anomalously high), the correlations between indices of West African monsoon precipitation and Atlantic tropical cyclone activity are considerably weaker than in years when the overall conditions in the region are less conducive. Other more remote climate parameters, such as the phase of the Southern Oscillation, are less effective at modulating the nature of these interactions.

Geochemical analysis of sediments and interstitial water in sediment cores from the North-West African continental margin and from the Central Pacific

A. Continental slope sediments off Spanish-Sahara and Senegal contain up to 4% organic carbon and up to 0.4% total nitrogen. The highest concentrations were found in sediments from water depths between 1000 and 2000 m. The regional and vertical distribution of organic matter differs significantly. Off Spanish-Sahara the organic matter content of sediment deposited during glacial times (Wuerm, Late Riss) is high whereas sediments deposited during interglacial times (Recent, Eem) are low in organic matter. Opposite distribution was found in sediments off Senegal. The sediments contain 30 to 130 ppm of fixed nitrogen. In most sediments this corresponds to 2-8 % of the total nitrogen. Only in sediments deposited during interglacial times off Spanish-Sahara up to 20 % of the total nitrogen is contained as inorganically bound nitrogen. Positive correlations of the fixed nitrogen concentrations to the amounts of clay, alumina, and potassium suggest that it is primarily fixed to illites. The amino acid nitrogen and hexosamine nitrogen account for 17 to 26 % and 1.3 to 2.4 %, respectively of the total nitrogen content of the sediments. The concentrations vary between 200 and 850 ppm amino acid nitrogen and 20 to 70 ppm hexosamine nitrogen, both parallel the fluctiations of organic matter in the sediment. Fulvic acids, humic acids, and the total organic matter of the sediments may be clearly differentiated from one another and their amino acid and hexosamine contents and their amino acid composition: a) Fulvic acids contain only half as much amino acids as humic acids b) The molar amino acid/hexosamine ratios of the fulvic acids are half those of the humic acids and the total organic matter of the sediment c) The amino acid spectra of fulvic acids are characterized by an enrichment of aspartic acid, alanine, and methionine sulfoxide and a depletion of glycine, valine, isoleucine, leucine, tyrosine, phenylalanine, lysine, and arginine compared to the spectra of the humic acids and those of the total organic matter fraction of the sediment. d) The amino acid spectra of the humic acids and those of the total organic matter fraction of the sediments are about the same with the exception that arginine is clearly enriched in the total organic matter. In general, as indicated by the amino compounds humic acids resemble closer the total organic matter composition than the low molecular fulvic acids do. This supports the general idea that during the course of diagenesis in reducing sediments organic matter stabilizes from a fulvic-like structure to humic-like structure and finally to kerogen. The decomposition rates of single aminio acids differ significantly from one another. Generally amino acids which are preferentially contained in humic acids and the total organic matter fraction show a smaller loss with time than those preferably well documented in case of the basic amino acids lysine and arginine which- although thermally unstable- are the most stable amino acids in the sediments. A favoured incorporation of these compounds into high molecular substances as well as into clay minerals may explain their relatively high "stability" in the sediment. The nitrogen loss from the sediments due to the activity of sulphate-reducing bacteria amounts to 20-40 % of the total organic nitrogen now present. At least 40 % of the organic nitrogen which is liberated by sulphate-reducing bacteria can be explained ny decomposition of amino acids alone. B. Deep-sea sediments from the Central Pacific The deep-seas sediments contain 1 to 2 orders of magnitude less organic matter than the continental slope sediments off NW Africa, i.e. 0.04 to 0.3 % organic carbon. The fixed nitrogen content of the deep-sea sediments ranges from 60 to 270 ppm or from 20 to 45 % of the total nitrogen content. While ammonia is the prevailing inorganic nitrogen compound in anoxic pore waters, nitrate predominates in the oxic environment of the deep-sea sediments. Near the sediment/water interface interstital nitrate concentrations of around 30 µg-at. N/l were recorded. These generally increase with sediment depth by 10 to 15 µg-at. NO3- N/l. This suggests the presence of free oxygen and the activity of nitrifying bacteria in the interstitial waters. The ammonia content of the interstitial water of the oxic deep-sea sediments ranges from 2 to 60 µg-at. N/l and thus is several orders of magnitude less than in anoxic sediments. In contrast to recorded nitrate gradients towards the sediments/water interface, there are no ammonia concentration gradients. However, ammonia concentrations appear to be characteristic for certain regional areas. It is suggested that this regional differentiation is caused by ion exchange reactions involving potassium and ammonium ions rather than by different decomposition rates of organic matter. C. C/N ratios All estimated C/N ratios of surface sediments vary between 3 and 9 in the deep-sea and the continental margin, respectively. Whereas the C/N ratios generally increase with depth in the sediment cores off NW Africa they decrease in the deep-sea cores. The lowest values of around 1.3 were found in the deeper sections of the deep-sea cores, the highest of around 10 in the sediments off NW Africa. The wide range of the C/N ratios as well as their opposite behaviour with increasing sediment depth in both the deep-sea and continental margin sediment cores, can be attributed mainly to the combination of the following three factors: 1. Inorganic and organic substances bound within the latticed of clay minerals tend to decrease the C/N ratios. 2. Organic matter not protected by absorption on the clay minerals tends to increase C/N ratios 3. Diagenetic alteration of organic matter by micro-organisms tends to increase C/N ratios through preferential loss of nitrogen The diagenetic changes of the microbially decomposable organic matter results in both oxic and anoxic environments in a preferential loss of nitrogen and hence in higher C/N ratios of the organic fraction. This holds true for most of the continental margin sediments off NW Africa which contain relatively high amounts of organic matter so that factors 2 and 3 predominate there. The relative low C/N ratios of the sediments deposited during interglacial times off Spanish-Sahara, which are low in organic carbon, show the increasing influence of factor 1 - the nitrogen-rich organic substances bound to clay minerals. In the deep-sea sediments from the Central Pacific this factor completely predominates so that the C/N rations of the sediments approach that of the substance absorbed to clay minerals with decreasing organic matter content. In the deeper core sections the unprotected organic matter has been completely destroyed so that the C/N ratios of the total sediments eventually fall into the same range as those of the pure clay mineral fraction.

Benthic foraminifera of surface sediments from the continental slope off Sierra Leone, North-West Africa

On "Meteor" cruise 30 (1973) 22 piston-cores were collected off Sierra Leone from water-depths between about 5000 m (Sierra Leone Basin) and 500 m (upper continental slope) with the objective to study the sediment composition and age as well as processes of sedimentation on the continental slope in a tropical humid region. Granulometric analysis and determinations of the carbonate contents of the sediment samples were carried out, as well as qualitative and quantitative analysis of the components of the grain size fractions > 63 µm and of the planktonic and benthonic foraminifera > 160 µm. Presently, the cold Canary Current influences the composition of the planktonic foraminifera within the northwestern area of investigation (profile A), whereas the planktonic fauna of the eastern area (profile C) seems to be truly tropical. In all Quaternary sediments from the continental slope off Sierra Leone, species of Globorotalia are less abundant than in truly pelagic sediments. For that reason, the zonation of the Pleistocene sediments based on the presence or absence of Globorotalia cultrata does not always agree with the climatic changes reflected in the sediments. Concerning past climates better results can be obtained by using the changes in percentage abundances of Globigerina sp. sp. and Globigerinoides sp. sp. as indicators for cool and warm temperatures. The Tertiary sediments contain a pelagic foraminiferal assemblage. In the Holocene sediments the benthonic foraminifera do not only serve as good paleodepth indicators, but their communities are also restricted to defined water masses, which change their positions in accordance with climatic changes. Thus, Cassidulina carinata in the area of investigation is an excellent indicator for sediments deposited during times, which were cooler than today; this is true for all cores from the continental slope off Sierra Leone independent of water-depth although this species presently abounds at water-depths around 600 m. The cores from the continental rise and from the Sierra Leone Basin (M30-261, M30-146, M30-147) were deposited below the calcium carbonate compensation depth. Only small sections of the cores consist of the original carbonate-free sediments, whereas the main part of the sediment column is redeposited material, rich in foraminifera, which normally live on the upper continental slope, or even on the shelf. From these cores only M30-261 can be subdivided into biostratigraphic zones ranging from zone V to zone Y. In all cores from the middle and upper continental slope of the eastern area of investigation (profile C; KL 230, 209-204) and in cores KL 183 and KL 184 from the northwestern area (profile A) we observed an undisturbed succession of sediments from the biostratigraphic zones X (partly), Y and Z. All cores from the central area (M30-181, M30-182, M30-262 to 264) and M30-187 from the upper slope of profile A show variable hiatuses in the sedimentary record. Locally, high velocity bottom currents were probably responsible for erosion, nondeposition or minimal sedimentation rates. These currents might have been initiated partly by the somewhat exposed position of this part of the continental slope, where the shelf edge bends from a northwest towards an eastern direction, and partly by very young tectonic movements. Fracture zones with vertically displaced fault blocs are frequent at Sierra Leone continental margin. According to seismic measurements by McMaster et al. (1975) the sites of the central area are located on an uplifted fault bloc explaining the reduced sediment rates or erosion. Unlike the central area, the eastern area (profile C) is situated on a downfaulted bloc with high sediment rates. The sediments from the cores of profile B as well as the turbiditic deep-sea sediments were deposited under a higher flow regime; therefore they are coarser than the extremely fine-grained sediments of the cores from profile C. Since the sand fraction (> 63 µm) is mainly composed of foraminifera, besides pteropods and light-colored fecal pellets, the carbonate content increases with the increasing percentage of the coarse grain fraction. Higher concentrations of quartz were only observed in core sections with considerable carbonate dissolution (mainly in the X-Zone), and, in general, in all sediments from the eastern area with higher terrigenous input including larger concentration of mica. Especially during times transitional between glacials and interglacials (or interstadials) the bottom currents were intensified. The percentages of coarse fraction and carbonate increase with increasing current velocities. Calcium carbonate dissolution becomes important in water depths > 3500 m. During cooler times the lysokline is depressed. Light-colored fecal pellets were redeposited from Late Neogene sediments (M30-187, M30-181). In the area of investigation they occur in the Holocene and mainly the Pleistocene sediments of the cores from the northwestern and central area because only here Tertiary sediments have been eroded at the uppermost continental slope. In the central area there are at least two periods of non-sedimentation and/or erosion which can be confined as being (1) not older than middle Pliocene and not younger than zone V and (2) younger than zone W. The local character of the erosion is documented by the fact that a complete Late Quaternary section is present in the cores of the northwestern and eastern area, each within less than 100 km from incomplete cores from the central area.

Farming strategy of African smallholder farmers in transition from traditional to alternative agriculture : the case of the Nupe in central Nigeria

It is worthwhile to understand farming strategies of smallholder farmers in sub-Saharan Africa, especially those of farmers who are in transition from traditional to alternative agriculture in terms of adoption of innovative technologies. In a case study of inland valleys in central Nigeria, we investigated the farming strategy of Nupe farmers who have a long-term tradition of wet rice cultivation and indigenous methods of land preparation for soil, water and weed management. In this region, a new method of land preparation has recently been introduced along with a recommendation to use improved seeds and chemical fertilizers. Our findings reveal that Nupe farmers directly sow traditional seeds and apply a marginal amount of fertilizer to paddy plots prepared by labor-saving methods on drought-prone hydromorphic valley fringes and flood-susceptible valley bottoms, whereas they preferentially transplanted improved seedlings and applied a relatively large quantity of fertilizer to paddy fields prepared by a labor-intensive and mechanized method on a valley position where they can access to optimum water condition (less risky against the drought and flood).

Geodynamic events reconstructed in the Betic, Maghrebian, and Apennine chains (central-western Tethys)

A synthetic study has been made to identify main tectono-sedimentary and geodynamic events in central-western Tethys. For this, an interdisciplinary analysis has been performed on successions belonging to tectonic units derived from Betic-Maghrebian-southern Apennine “Flysch basin” domain. The stratigraphic records of the internal, external, and mixed successions deposited in lateral basins of different chains show very similar characters, especially regarding: (a) lithostratigraphy and ages; (b) kind and provenance of supplies (immature and supermature petrofacies from internal and external margins, respectively); (c) presence of “mixed successions” (composed of alternating internal and external petrofacies) attesting to clear palaeogeographic relationships between opposite depositional systems; and (d) timing of the deformation. In addition, specific lithofacies reveal correspondence with similar sedimentary events, such as: (1) very thick silicoclastic supply concentrated in restricted time ranges indicating the main deformational phases in the margin/basin systems; (2) levels rich in black-shales, glauconian, siliceous-producers, and volcaniclastic intercalations, widespread in the studied successions and linked to particular events at the Tethyan scale (anoxic periods, starvation-upwelling, acid-intermediate penecontemporaneous volcanic activity, respectively). Tectonic influence has also been recorded by means of unconformities and tectofacies (such as turbidites, slumps, or olisthostromes, etc.), being correlated with the main deformational phases. Similar stratigraphic and tectonic events have also been found in the Calvana unit of Val Marecchia nappe (Ligurides, northern Apennine). Correlations of stratigraphic and tectonic events support the proposal of an evolutionary geodynamic model involving the presence of a “Mesomediterranean microplate” in intermediate position during Africa-Europe convergence. The closure of central-western Tethys occasioned the Betic-Maghrebian-southern Apennine oceanic branch deformation and the birth of perimediterranean chains during middle-late Miocene.

Cape Town, South Africa, 1911 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Map of Cape Town (Central). It was published by Cape Peninsula Publicity Association in 1911. Scale [ca. 1:4,700]. Covers a portion of Cape Town, South Africa. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Universal Transverse Mercator (UTM Zone 34S, meters, WGS 1984) projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as roads, railroads and stations, street-railroads, drainage, selected buildings and tourist attractions, parks, and more. Includes inset location map and an index to points of interest.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Red Sea Region, North Africa, ca. 1730 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Carte de l'Egypte, de la Nubie, de l'Abyssinie &c., par Guillaume de l'Isle, de l'Academie Royal a Paris. It was published by Chez Henri de Leth, a l'enseigne du Pecheur ca. 1730. Scale [ca. 1:9,250,000]. Covers the Red Sea region, North Africa including portions of the Middle East and Europe. Map in French.The image inside the map neatline is georeferenced to the surface of the earth and fit to the Africa Sinusoidal projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, major roads, cities and other human settlements, territorial boundaries, shoreline features, and more. Relief shown pictorially. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Africa, 1800 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Africa. It was published by Calcogafia Vignozzi in 1800. Scale [ca. 1:30,000,000]. The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'World Aitoff' projection with the central meridian at 20 degrees east. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, territorial boundaries, shoreline features, and more. Relief is shown pictorially.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

Africa, Catholic Missions and Colonial Possessions, 1889 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Tiré de l'ouvrage les missions catholiques d'Afrique en 1889, par le Baron Léon Bethune. It was published by Société de St. Augustin in 1889. Scale 1:20,000,000. Map in French.The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'World Sinusoidal' projection with the central meridian at 20 degrees east. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, colonial possessions, ecclesiastical districts, and more. Relief is shown by hachures. Includes index.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

Africa with expedition routes, 1865 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Karte von Afrika nach den neuesten Forschungen : mit Angabe der wichtigsten Entdeckungswege, bearbeitet und gezeichnet von Henry Lange. It was published by Otto Purfürst in 1865. Scale 1:14,250,000. Covers also Madagascar and part of the Arabian peninsula. The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'World Sinusoidal' projection with the central meridian at 25 degrees east. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, roads, expedition routes, and more. Relief is shown by hachures. Includes legend of expedition routes. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.