Age in antiretroviral therapy programmes in South Africa: a retrospective, multicentre, observational cohort study.

BACKGROUND As access to antiretroviral therapy (ART) expands, increasing numbers of older patients will start treatment and need specialised long-term care. However, the effect of age in ART programmes in resource-constrained settings is poorly understood. The HIV epidemic is ageing rapidly and South Africa has one of the highest HIV population prevalences worldwide. We explored the effect of age on mortality of patients on ART in South Africa and whether this effect is mediated by baseline immunological status. METHODS In this retrospective cohort analysis, we studied HIV-positive patients aged 16-80 years who started ART for the first time in six large South African cohorts of the International Epidemiologic Databases to Evaluate AIDS-Southern Africa collaboration, in KwaZulu-Natal, Gauteng, and Western Cape (two primary care clinics, three hospitals, and a large rural cohort). The primary outcome was mortality. We ascertained patients' vital status through linkage to the National Population Register. We used inverse probability weighting to correct mortality for loss to follow-up. We estimated mortality using Cox's proportional hazards and competing risks regression. We tested the interaction between baseline CD4 cell count and age. FINDINGS Between Jan 1, 2004, and Dec 31, 2013, 84,078 eligible adults started ART. Of these, we followed up 83,566 patients for 174,640 patient-years. 8% (1817 of 23,258) of patients aged 16-29 years died compared with 19% (93 of 492) of patients aged 65 years or older. The age adjusted mortality hazard ratio was 2·52 (95% CI 2·01-3·17) for people aged 65 years or older compared with those 16-29 years of age. In patients starting ART with a CD4 count of less than 50 cells per μL, the adjusted mortality hazard ratio was 2·52 (2·04-3·11) for people aged 50 years or older compared with those 16-39 years old. Mortality was highest in patients with CD4 counts of less than 50 cells per μL, and 15% (1103 of 7295) of all patients aged 50 years or older starting ART were in this group. The proportion of patients aged 50 years or older enrolling in ART increased with successive years, from 6% (290 of 4999) in 2004 to 10% (961 of 9657) in 2012-13, comprising 9% of total enrolment (7295 of 83 566). At the end of the study, 6304 (14%) of 44,909 patients still alive and in care were aged 50 years or older. INTERPRETATION Health services need reorientation towards HIV diagnosis and starting of ART in older individuals. Policies are needed for long-term care of older people with HIV. FUNDING National Institutes of Health (National Institute of Allergy and Infectious Diseases), US Agency for International Development, and South African Centre for Epidemiological Modelling and Analysis.

Physical-Biological Oceanographic Coupling Influencing Phytoplankton and Primary Production in the South China Sea

Two cruises were carried out in the summer and winter of 1998 to study coupled physical-chemical-biological processes in the South China Sea and their effects on phytoplankton stock and production. The results clearly show that the seasonal distributions of phytoplankton were closely related to the coupled processes driven by the East Asian Monsoon. Summer southwesterly monsoon induced upwelling along the China and Vietnam coasts. Several mesoscale cyclonic cold eddies and anticyclonic warm pools were identified in both seasons. In the summer, the upwelling and cold eddies, both associated with rich nutrients, low dissolved oxygen ( DO), high chlorophyll a (Chl a) and primary production ( PP), were found in the areas off the coast of central Vietnam, southeast of Hainan Island and north of the Sunda shelf, whereas in the winter they form a cold trough over the deep basin aligning from southwest to northeast. The warm pools with poor nutrients, high DO, low Chl a, and PP were found in the areas southeast of Vietnam, east of Hainan, and west of Luzon during the summer, and a northwestward warm jet from the Sulu Sea with properties similar to the warm pools was encountered during the winter. The phytoplankton stock and primary production were lower in summer due to nutrient depletion near the surface, particularly PO4. This phosphorus depletion resulted in phytoplankton species succession from diatoms to dinoflagellates and cyanophytes. A strong subsurface Chl a maximum, dominated by photosynthetic picoplankton, was found to contribute significantly to phytoplankton stocks and production.

From Truth to Justice: How Does Amnesty Factor In? A Comparative Analysis of South Africa and Sierra Leone's Truth and Reconciliation Commissions

Truth and Reconciliation Commissions (TRC) have emerged in the last few decades as a mechanism for a state to overcome widespread, grave, human rights violations. There are numerous approaches to a TRC all with an ultimate goal: that formerly warring factions, perpetrators, witnesses, and victims can move forward as a united people. I propose that the provision of amnesty is critical to the success of a TRC. I hypothesize that the form of amnesty chosen (i.e. blanket v. conditional amnesty) determines the revelation of truth and realization of justice, which in turn dictates whether a TRC can achieve reconciliation. To test this hypothesis, I use two case studies: South Africa, which has utilized conditional amnesty, and Sierra Leone which has employed blanket amnesty. I create a model for measuring reconciliation. I can then look at the implications of both types of amnesty and assess which, in the end, is more effective. My overarching conclusion is that the provision of conditional amnesty is more effective than blanket amnesty in achieving reconciliation. Ultimately, I hope that this conclusion can be generalized to other TRCs.

Oxygen and carbon isotopic composition of shells from Radix sp. in lakes across the Tibetan Plateau

The Tibetan Plateau (TP), including its surrounding mountain ranges, represents the largest store of ice outside the polar regions. It hosts numerous lakes as well as the head waters of major Asian rivers, on which billions of people depend, and it is particularly sensitive to climate change. The moisture transport to the TP is controlled by the Indian and Pacific monsoon and the Westerlies. Understanding the evolution of the interaction of these circulation systems requires studies on climate archives in different spatial and temporal contexts. The objective of this study is to learn more about the interannual variability of precipitation patterns across the TP and how different hydrologic systems react to different climatic factors. Aragonite shells of the aquatic gastropod Radix, which is widely distributed in the region, may represent suitable archives for inferring hydrologic and climatic signals in particularly high resolution. Therefore, sclerochronological studies of d18O and d13C ratios in Radix shells from seven lakes were conducted, each representing a different hydrologic and climatic setting, on a transect from the Pamirs across the TP. The shell patterns exhibit an increasing influence of precipitation and a decreasing influence of evaporation on the isotope compositions from west to east. d18O values of shells from lakes on the eastern and central TP (Donggi Cona, Yamdrok Yumco, Tarab Co) mirror monsoon signals, indicated by more negative values and higher variabilities compared to the more western lakes (Karakul, Bangong/Nyak, Manasarovar). In Yadang Co, located on the central southern TP, the monsoon rains did not reach the lake in the sampling year, although it is located in a region which is usually affected by monsoon circulation. The d18O values are used to differentiate the annual hydrological cycle into ice cover period, melt water period, precipitation period and evaporation period. d13C compositions in the shells particularly depend on specific habitats, which vary in biological productivity and in carbon sources. d18O and d13C patterns show a positive covariance in shells originating from large closed basins. The results show that Radix shells mirror general climatic differences between the seven lake regions. These differences reflect both regional and local climate signals in sub-seasonal resolution, without noticeable dependence on the particular lake system.

Sedimentology on 19 cores from the South China Sea

Based on the study of 10 sediment cores and 40 core-top samples from the South China Sea (SCS) we obtained proxy records of past changes in East Asian monsoon climate on millennial to bidecadal time scales over the last 220,000 years. Climate proxies such as global sea level, estimates of paleotemperature, salinity, and nutrients in surface water, ventilation of deep water, paleowind strength, freshwater lids, fluvial and/or eolian sediment supply, and sediment winnowing on the sea floor were derived from planktonic and benthic stable-isotope records, the distribution of siliciclastic grain sizes, planktonic foraminifera species, and the UK37 biomarker index. Four cores were AMS-14C-dated. Two different regimes of monsoon circulation dominated the SCS over the last two glacial cycles, being linked to the minima and maxima of Northern Hemisphere solar insolation. (1) Glacial stages led to a stable estuarine circulation and a strong O2-minimum layer via a closure of the Borneo sea strait. Strong northeast monsoon and cool surface water occurred during winter, in part fed by an inflow from the north tip of Luzon. In contrast, summer temperatures were as high as during interglacials, hence the seasonality was strong. Low wetness in subtropical South China was opposed to large river input from the emerged Sunda shelf, serving as glacial refuge for tropical forest. (2) Interglacials were marked by a strong inflow of warm water via the Borneo sea strait, intense upwelling southeast of Vietnam and continental wetness in China during summer, weaker northeast monsoon and high sea-surface temperatures during winter, i.e. low seasonality. On top of the long-term variations we found millennial- to centennial-scale cold and dry, warm and humid spells during the Holocene, glacial Terminations I and II, and Stage 3. The spells were coeval with published variations in the Indian monsoon and probably, with the cold Heinrich and warm Dansgaard-Oeschger events recorded in Greenland ice cores, thus suggesting global climatic teleconnections. Holocene oscillations in the runoff from South China centered around periodicities of 775 years, ascribed to subharmonics of the 1500-year cycle in oceanic thermohaline circulation. 102/84-year cycles are tentatively assigned to the Gleissberg period of solar activity. Phase relationships among various monsoon proxies near the onset of Termination IA suggest that summer-monsoon rains and fluvial runoff from South China had already intensified right after the last glacial maximum (LGM) insolation minimum, coeval with the start of Antarctic ice melt, prior to the d18O signals of global sea-level rise. Vice versa, the strength of winter-monsoon winds decreased in short centennial steps only 3000-4000 years later, along with the melt of glacial ice sheets in the Northern Hemisphere.

Stable carbon and oxygen isotope ratios of foraminifera in surface sediments of the South China Sea

The relationship between planktonic and benthic foraminiferal stable-isotope values and oceanographic conditions and factors controlling isotopic variations are discussed on the basis of oxygen and carbon isotopic analyses of 192 modern surface and Last Glacial Maximum (LGM) samples from the South China Sea (SCS). The harmonic variation of benthic delta18O in surface sediments with water depth and temperature implies that the temperature is the main factor influencing benthic delta18O variations. Planktonic delta18O fluctuates with sea surface temperature (SST) and salinity (SSS). The N-S temperature gradient results in planktonic delta18O decreasing from the northeast to the south. Cool, saline waters driven by the winter monsoon are interpreted to have been responsible for the high delta18O values in the northeast SCS. The East Asian monsoons not only bring nutrients into the South China Sea and maintain high nutrient concentration levels at the southwestern and northeastern ends, which cause depleted delta13C both in planktonic (surface) and benthic (bottom) samples but also reduce planktonic/benthic delta18O differences. The distribution of delta18O and delta13C in the surface and LGM samples are strikingly similar, indicating that the impact of SST and SSS has been maintained, and nutrient inputs, mainly from the northeastern and southwestern ends, have been controlled by monsoons since the LGM. Comparisons of the modern and LGM delta18O indicate a difference of about 3.6 °C in bottom-water temperature and a large surface-to-bottom temperature gradient during the LGM as compared to today.

Sedimentology and stable oxygen isotope record of the northern South China Sea

High-resolution sediment records from the South China Sea reveal a winter monsoon dominated glacial regime and a summer monsoon dominated Holocene regime during the last glacial cycle. A fundamental change between regimes occurred during deglaciation through a series of millennial reoccurrences of century-scale changes in the East Asian monsoon (EAM) climate. These abrupt events centered at 17.0, 15.9, 15.5, 14.7, 13.5, 13.9, 13.3, 12.1, 11.5, and 10.7 14C ka correlate well with the millennial-scale events in the Santa Barbara Basin and the Arabian Sea, i.e. a relationship between EAM and El Niño/Southern Oscillation systems. The abrupt increases in summer monsoon imply enhanced heat transport from low-latitude sea area to the midlatitude/high-latitude land area. The phase relationship between events of EAM and ice sheet may reflect a faster EAM response and a slower ice sheet response to the insolation change. A far-reaching conclusion is that the EAM might have triggered the Northern Hemisphere deglaciation.

Major element and mineral composition of gabbroic xenoliths and megacrysts from Jeju Island, South Korea

Gabbroic xenoliths and diverse megacrysts (e.g., clinopyroxenes, amphiboles and plagioclases), which correspond to the lithology ranging from gabbro-norite to gabbro, occur in the Pleisto-Holocene alkali basalts from Jeju Island, South Korea. The gabbroic xenoliths consist primarily of moderate-K2O plagioclase, Ti-Al-rich clinopyroxene and CaO-rich orthopyroxene; additionally, TiO2-rich amphibole (kaersutite) and Ti-Fe oxides might or might not be present. The plagioclase is the most dominant phase (approx. 60-70 vol.%). The xenoliths and megacrysts provide evidence for the modal metasomatism of the lower continental crust by the mafic magmas during the Pleistocene. The coarse grain size (up to 5 mm), moderate Mg# [=100xMg/(Mg+Fe(total)) atomic ratio] of pyroxenes (70-77) and textural features (e.g., poikilitic) indicate that the gabbroic xenoliths are consistent with a cumulus origin. The clinopyroxenes from these xenoliths are enriched in REE with smooth convex-upward MREE patterns, which are expected for cumulus minerals formed from a melt enriched in incompatible trace elements. The strikingly similar major and trace element variations and the patterns of constituent minerals clearly indicate a genetic link between the gabbroic xenoliths (plus megacrysts) and the host basalt, indicating that the xenoliths belong to the Jeju Pleisto-Holocene magma system. On the basis of the textural features, the mineral equilibria and the major and trace element variations, the xenoliths appear to have crystallized from basaltic melts at the reservoir-roof environment within the lower crust (4-7 kbars) above the present Moho estimates beneath Jeju Island, where the xenoliths represent wall rocks. Following the consolidation of the xenolith lithologies, volatile- and incompatible element-enriched melt/fluid, as metasomatic agents, infiltrated through the grain boundaries and/or cracks and reacted with the preexisting anhydrous phases, which produced the metasomatic amphiboles. This volatile-enriched melt/fluid could have evolved from the initially anhydrous compositions to the volatile-saturated compositions by the active fractional crystallization in the Jeju Pleisto-Holocene magma system. This process was significant in that it was a relatively young event and played an important role in the formation of the hydrous minerals and the metasomatization of the lower continental crust, which is a plume-impacted area along the Asian continental margin. The major and trace element analyses of the mineral phases from the xenoliths were performed to define the principal geochemical characteristics of the crustal lithosphere segment represented by the studied xenoliths.

Miocene flora and paleoclimate estimations of Schrotzburg, South Germany

We present a detailed palaeoclimate analysis of the Middle Miocene (uppermost Badenian-lowermost Sarmatian) Schrotzburg locality in S Germany, based on the fossil macro- and micro-flora, using four different methods for the estimation of palaeoclimate parameters: the coexistence approach (CA), leaf margin analysis (LMA), the Climate-Leaf Analysis Multivariate Program (CLAMP), as well as a recently developed multivariate leaf physiognomic approach based on an European calibration dataset (ELPA). Considering results of all methods used, the following palaeoclimate estimates seem to be most likely: mean annual temperature ~15-16°C (MAT), coldest month mean temperature ~7°C (CMMT), warmest month mean temperature between 25 and 26°C, and mean annual precipiation ~1,300 mm, although CMMT values may have been colder as indicated by the disappearance of the crocodile Diplocynodon and the temperature thresholds derived from modern alligators. For most palaeoclimatic parameters, estimates derived by CLAMP significantly differ from those derived by most other methods. With respect to the consistency of the results obtained by CA, LMA and ELPA, it is suggested that for the Schrotzburg locality CLAMP is probably less reliable than most other methods. A possible explanation may be attributed to the correlation between leaf physiognomy and climate as represented by the CLAMP calibration data set which is largely based on extant floras from N America and E Asia and which may be not suitable for application to the European Neogene. All physiognomic methods used here were affected by taphonomic biasses. Especially the number of taxa had a great influence on the reliability of the palaeoclimate estimates. Both multivariate leaf physiognomic approaches are less influenced by such biasses than the univariate LMA. In combination with previously published results from the European and Asian Neogene, our data suggest that during the Neogene in Eurasia CLAMP may produce temperature estimates, which are systematically too cold as compared to other evidence. This pattern, however, has to be further investigated using additional palaeofloras.

Holocene corals from the South China Sea

The South China Sea (SCS) is well connected with the western Pacific and influenced by the East Asian monsoon. We have examined temporal variations in radiocarbon marine reservoir ages (R) and regional marine reservoir corrections (DeltaR) of the SCS during the Holocene using paired measurements of AMS 14C and TIMS 230Th on 20 pristine corals. The results show large fluctuations in both R and DeltaR values over the past 7500 years (yrs) with two distinct plateaus during 7.5-5.6 and 3.5-2.5 thousand calendar years before present (cal ka BP). The respective weighted mean DeltaR values of these plateaus are 151 ± 85 and 89 ± 59 yrs, which are significantly higher than its modern value of -23 ± 52 yrs. This suggests that using a constant modern DeltaR value to calibrate 14C dates of the SCS marine samples will introduce additional errors to the calibrated ages. Our results provide the first database for the Holocene R and DeltaR values of the SCS for improved radiocarbon calibration of marine samples. We interpret the two DeltaR plateaus as being related to two intervals with weakened El Niño - Southern Oscillation (ENSO) and intensified East Asian summer monsoon (EASM). This is because the 14C content of the SCS surface water is controlled by both the 14C concentration of the Pacific North Equatorial Current (NEC) which is in turn influenced by ENSO-induced upwelling along the Pacific equator and vertical upwelling within the SCS as a result of moisture transportation to midlatitude region to supply the EASM rainfall.

High resolution color reflectance and hematite and goethite record of ODP Hole 184-1143A in the South China Sea

Precipitation has a larger variability than temperature in tropical monsoon regions, thus it is an important climate variable. However, reconstructions of long-term rainfall histories are scarce because of the lack of reliable proxies. Here we document that iron oxide minerals, specifically the ratio of hematite to goethite (Hm/Gt), is a reasonable precipitation proxy. Using diffuse reflectance spectrophotometry, we measured samples from Ocean Drilling Program (ODP) 1143 drilling site (9°21.72'N, 113°17.11'E, 2777 m water depth) for hematite and goethite, whose formation processes are favored by opposing climate conditions. In order to determine the content of hematite and goethite we produced a set of calibration samples by removing the iron oxides to generate the natural matrix to which hematite and goethite in known percentages were added. From these calibration samples we developed a transfer function for determining hematite and goethite concentration from a sample's spectral reflectance. Applying this method to ODP 1143 sediments (top 34 m of a 510 m core with sampling interval of 10 cm) we were able to reconstruct a continuous precipitation history for SE Asia of the past 600 kyr using the Hm/Gt ratio as a proxy of the precipitation variability of Asian monsoon. The reliability of this Hm/Gt proxy is corroborated by its consistency with the stalagmite delta18O data from South China. Comparing long-term Hm/Gt records with the surface temperature gradient of equatorial Pacific Ocean, we found that monsoon precipitation and El Niño are correlated for the last 600 kyr. The development of El Niño-like conditions decreased SE Asia precipitation, whereas precipitation increases in response to La Niña intensification

Strontium measurements and sea surface temperatures of corals from Xisha Island, South China Sea

A Porites coral collected from Xisha Island, South China Sea, represents a skeleton secreted in the period from 1906 to 1994. The Sr contents of the coral vary linearly with the instrument-measured sea-surface temperature (SST), giving a Sr thermometer: SST = -1.9658 x Sr + 193.26. The reconstructed SST data show that the late 20th century was warmer (about 1°C) than the early 20th century and that two cooling (1915/1916 and 1947/1948) and three warming (1935/1936, 1960/1961, and 1976/1977) shifts occurred in the century. The temperature shifts are more pronounced for winters, implying a close effect of the west Pacific warm pool and Asian monsoon and suggesting that the former is a primary force controlling the climatic system of the region. Results of this study and previously published data indicate a close link of temperature shifts between the boreal summer and the austral winter or the boreal winter and the austral summer. The annual SST anomalies in the South China Sea and the South Pacific reveal the existence of harmonic but opposite SST variations between the two regions. On the decadal scale the comparative annual SST anomalies for the South China Sea and for the equatorial west Pacific show a similarity in temperature variations, implying that the South China Sea climate is coherent with climatic regime of the tropical west Pacific.