Are They Really Lost? "True" Status and Reasons for Treatment Discontinuation among HIV Infected Patients on Antiretroviral Therapy Considered Lost to Follow Up in Urban Malawi

INTRODUCTION Patients who are lost to follow-up (LTFU) while on antiretroviral therapy (ART) pose challenges to the long-term success of ART programs. We describe the extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on ART and explain reasons for ART discontinuation using our active tracing program to further improve ART retention programs and policies. METHODS We identified adult ART patients who missed clinic appointment by more than 3 weeks between January 2006 and December 2010, assuming that such patients would miss their doses of antiretroviral drugs. Patients considered LTFU who consented during ART registration were traced by phone or home visits; true ART status after tracing was documented. Reasons for ART discontinuation were also recorded for those who stopped ART. RESULTS Of the 4,560 suspected LTFU cases, 1,384 (30%) could not be traced. Of the 3,176 successfully traced patients, 952 (30%) were dead and 2,224 (70%) were alive, of which 2,183 (99.5%) started ART according to phone-based self-reports or physical verification during in-person interviews. Of those who started ART, 957 (44%) stopped ART and 1,226 (56%) reported still taking ART at the time of interview by sourcing drugs from another clinic, using alternative ART sources or making brief ART interruptions. Among 940 cases with reasons for ART discontinuations, failure to remember (17%), too weak/sick (12%), travel (46%), and lack of transport to the clinic (16%) were frequently cited; reasons differed by gender. CONCLUSION The LTFU category comprises sizeable proportions of patients still taking ART that may potentially bias retention estimates and misdirect resources at the clinic and national levels if not properly accounted for. Clinics should consider further decentralization efforts, increasing drug allocations for frequent travels, and improving communication on patient transfers between clinics to increase retention and adherence.

Countering the urbanist agenda in variationist sociolinguistics: dialect contact, demographic change and the rural-urban dichotomy

In variational linguistics, the concept of space has always been a central issue. However, different research traditions considering space coexisted for a long time separately. Traditional dialectology focused primarily on the diatopic dimension of linguistic variation, whereas in sociolinguistic studies diastratic and diaphasic dimensions were considered. For a long time only very few linguistic investigations tried to combine both research traditions in a two-dimensional design – a desideratum which is meant to be compensated by the contributions of this volume. The articles present findings from empirical studies which take on these different concepts and examine how they relate to one another. Besides dialectological and sociolinguistic concepts also a lay perspective of linguistic space is considered, a paradigm that is often referred to as “folk dialectology”. Many of the studies in this volume make use of new computational possibilities of processing and cartographically representing large corpora of linguistic data. The empirical studies incorporate findings from different linguistic communities in Europe and pursue the objective to shed light on the inter-relationship between the different concepts of space and their relevance to variational linguistics.

Water quality and health in a Sahelian semi-arid urban context: an integrated geographical approach in Nouakchott, Mauritania

Access to sufficient quantities of safe drinking water is a human right. Moreover, access to clean water is of public health relevance, particularly in semi-arid and Sahelian cities due to the risks of water contamination and transmission of water-borne diseases. We conducted a study in Nouakchott, the capital of Mauritania, to deepen the understanding of diarrhoeal incidence in space and time. We used an integrated geographical approach, combining socio-environmental, microbiological and epidemiological data from various sources, including spatially explicit surveys, laboratory analysis of water samples and reported diarrhoeal episodes. A geospatial technique was applied to determine the environmental and microbiological risk factors that govern diarrhoeal transmission. Statistical and cartographic analyses revealed concentration of unimproved sources of drinking water in the most densely populated areas of the city, coupled with a daily water allocation below the recommended standard of 20 l per person. Bacteriological analysis indicated that 93% of the non-piped water sources supplied at water points were contaminated with 10-80 coliform bacteria per 100 ml. Diarrhoea was the second most important disease reported at health centres, accounting for 12.8% of health care service consultations on average. Diarrhoeal episodes were concentrated in municipalities with the largest number of contaminated water sources. Environmental factors (e.g. lack of improved water sources) and bacteriological aspects (e.g. water contamination with coliform bacteria) are the main drivers explaining the spatio-temporal distribution of diarrhoea. We conclude that integrating environmental, microbiological and epidemiological variables with statistical regression models facilitates risk profiling of diarrhoeal diseases. Modes of water supply and water contamination were the main drivers of diarrhoea in this semi-arid urban context of Nouakchott, and hence require a strategy to improve water quality at the various levels of the supply chain.

Patient satisfaction and nursing staff work satisfaction in an urban public teaching hospital

This study examined the level of patient satisfaction and nursing staff work satisfaction at an urban public hospital in the Southwestern United States. The primary objectives of this study were to determine: (1) the level of overall patient satisfaction and satisfaction with specific dimensions of hospital care; (2) the differences in patient satisfaction according to demographic characteristics (age, gender, ethnicity, and education completed) and predispositional factors (perceived health status, perceived level of pain, prior contact with the hospital, and hospital image) and the relative importance of each variable on patient satisfaction; (3) the level of overall work satisfaction and satisfaction with specific dimensions of work experienced by the medical/surgical nursing staff; (4) the differences in work satisfaction experienced by the nursing staff based on demographic variables (age, gender, ethnicity, and marital status) and professional factors (education completed, staff position, the number of years employed with the hospital, and number of years employed in nursing) and the relative importance of each variable on work satisfaction; and (5) to determine the effect of the nursing work milieu on patient and staff satisfaction.^ The study findings showed that patients experienced a moderate to low level of satisfaction with the dimensions of hospital care (admission process, daily care, information, nursing care, physician care, other hospital staff, living arrangements, and overall care). Of the eight dimensions of care, patients reported a relatively positive level of satisfaction (75 percent or better) with only one dimension: physician care. Ethnicity, perceived health status, and hospital image were significantly related to patient satisfaction. Hispanic patients, those who were in good health, and those who felt the hospital had a good image in their community were most satisfied with hospital care. Patients also reported areas of hospital care that needed the most improvement. Responses included: rude staff, better nursing care, and better communication.^ Findings from the nursing satisfaction survey indicated a low level of satisfaction with the dimensions of work (autonomy, pay, professional status, interaction, task requirements, and organizational policies). Only one dimension of work, professional status, received a mean satisfaction score in the positive range. Additionally, staff members were unanimously dissatisfied with their salaries. Frequently mentioned work-related problems reported by the staff included: staffing shortages, heavy patient loads. and excessive paperwork.^ The nursing milieu appeared to have had a significant effect on the satisfaction levels of patients nursing staff employees. The nursing staff were often short staffed, which increased the patient-to-nurse ratio. Consequently, patients did not receive the amount of attention and care they expected from the nursing staff. Crowded patient rooms allowed for little personal space and privacy. Dissatisfaction with living conditions served to influence patients' attitudes and satisfaction levels. These frustrations were often directed toward their primary caregivers, the nursing staff. Consequently, the nursing milieu appeared to directly affect and influence the satisfaction levels of both patients and staff. (Abstract shortened by UMI). ^

The Beach in Anglophone Literatures and Cultures: Reading Littoral Space

From early colonial encounters to the ecological disasters of the twenty-first century, the performativity of contact has been a crucial element in the political significance of the beach. Conceptualising the beach as a creative trope and as a socio-cultural site, as well as an aesthetically productive topography, this collection examines its multiplicity of meanings and functions as a natural environment engendering both desire and fear in the human imagination from the Victorian period to the present. The contributors examine literature, film, and art, in addition to moments of encounter and environmental crisis, to highlight the beach as a social space inspiring particular codes of behaviour and specific discourses, as a geographical frontier between land and water, as an historical site of contact and conflict, and as a vacationscape promising regeneration and withdrawal from everyday life. The diversity of the beach is reflected in the geographical range, with essays on locales and texts from Britain, Ireland, the Caribbean, South Africa, the United States, Polynesia, and New Zealand. Focusing on the changed function of the beach as a result of processes of industrialisation and the rise of a modern leisure and health culture, this interdisciplinary volume theorises the beach as a demarcater of the precarious boundary between land and the sea, as well as between nature and culture.

Newton’s Metaphysics of Space as God’s Emanative Effect

In several of his writings, Isaac Newton proposed that physical space is God’s “emanative effect” or “sensorium,” revealing something interesting about the metaphysics underlying his mathematical physics. Newton’s conjectures depart from Plato and Aristotle’s metaphysics of space and from classical and Cambridge Neoplatonism. Present-day philosophical concepts of supervenience clarify Newton’s ideas about space and offer a portrait of Newton not only as a mathematical physicist but an independent-minded rationalist philosopher.

Urban expansion and its impact on urban agriculture – remote sensing based change analysis of Kizinga and Mzinga Valley – Dar Es Salaam, Tanzania

Urban agriculture is a phenomenon that can be observed world-wide, particularly in cities of devel-oping countries. It is contributing significantly to food security and food safety and has sustained livelihood of the urban and peri-urban low income dwellers in developing countries for many years. Population increase due to rural-urban migration and natural, coupled with formal as well as infor-mal urbanization are competing with urban farming for available space and scarce water resources. A multitemporal multisensoral urban change analysis over the period of 25 years (1982-2007) was performed in order to measure and visualize the urban expansion along the Kizinga and Mzinga valley in the South of Dar es Salaam. Airphotos and VHR satellite data were analyzed by using a combination of a composition of anisotropic textural measures and spectral information. The study revealed that unplanned built-up area is expanding continuously and vegetation covers and agricultural lands decline at a fast rate. The validation showed that the overall classification accuracy varied depending on the database. The extracted built-up areas were used for visual in-terpretation mapping purposes and served as information source for another research project. The maps visualize an urban congestion and expansion of nearly 18% of the total analyzed area that had taken place in the Kizinga valley between 1982 and 2007. The same development can be ob-served in the less developed and more remote Mzinga valley between 1981 and 2002. Both areas underwent fast changes where land prices still tend to go up and an influx of people both from rural and urban areas continuously increase density with the consequence of increasing multiple land use interests.

The sensitivity and specificity of a diagnostic test of sequence-space synesthesia

People with sequence-space synesthesia (SSS) report stable visuo-spatial forms corresponding to numbers, days, and months (amongst others). This type of synesthesia has intrigued scientists for over 130 years but the lack of an agreed upon tool for assessing it has held back research on this phenomenon. The present study builds on previous tests by measuring the consistency of spatial locations that is known to discriminate controls from synesthetes. We document, for the first time, the sensitivity and specificity of such a test and suggest a diagnostic cut-off point for discriminating between the groups based on the area bounded by different placement attempts with the same item.

Revolution to Revolution: Tracing Egyptian Public Art from Saad Zaghloul to January 25

Artists have spent a century claiming Egypt for the Egyptians. Now the powerful murals of January 25 have created a new public space dedicated to every citizen.

A space-time analysis of reported shigellosis and salmonellosis cases in Texas from 2000 to 2004

Background. The purpose of this study was to describe the risk factors and demographics of persons with salmonellosis and shigellosis and to investigate both seasonal and spatial variations in the occurrence of these infections in Texas from 2000 to 2004, utilizing time series analyses and the geographic information system digital mapping methods. ^ Methods. Spatial Analysis: MapInfo software was used to map the distribution of age-adjusted rates of reported shigellosis and salmonellosis in Texas from 2000–2004 by zip codes. Census data on above or below poverty level, household income, highest level of educational attainment, race, ethnicity, and urban/rural community status was obtained from the 2000 Decennial Census for each zip code. The zip codes with the upper 10% and lower 10% were compared using t-tests and logistic regression to determine whether there were any potential risk factors. ^ Temporal analysis. Seasonal patterns in the prevalence of infections in Texas from 2000 to 2003 were determined by performing time-series analysis on the numbers of cases of salmonellosis and shigellosis. A linear regression was also performed to assess for trends in the incidence of each disease, along with auto-correlation and multi-component cosinor analysis. ^ Results. Spatial analysis: Analysis by general linear model showed a significant association between infection rates and age, with young children aged less than 5 and those aged 5–9 years having increased risk of infection for both disease conditions. The data demonstrated that those populations with high percentages of people who attained a higher than high school education were less likely to be represented in zip codes with high rates of shigellosis. However, for salmonellosis, logistic regression models indicated that when compared to populations with high percentages of non-high school graduates, having a high school diploma or equivalent increased the odds of having a high rate of infection. ^ Temporal analysis. For shigellosis, multi-component cosinor analyses were used to determine the approximated cosine curve which represented a statistically significant representation of the time series data for all age groups by sex. The shigellosis results show 2 peaks, with a major peak occurring in June and a secondary peak appearing around October. Salmonellosis results showed a single peak and trough in all age groups with the peak occurring in August and the trough occurring in February. ^ Conclusion. The results from this study can be used by public health agencies to determine the timing of public health awareness programs and interventions in order to prevent salmonellosis and shigellosis from occurring. Because young children depend on adults for their meals, it is important to increase the awareness of day-care workers and new parents about modes of transmission and hygienic methods of food preparation and storage. ^

Convergencias y divergencias respecto de las poéticas de la década del '60 en tres proyectos de escritura : César Fernández Moreno, Joaquín Giannuzzi y Alfredo Veiravé

La crítica especializada reconoce dos líneas dominantes en el campo intelectual argentino a partir de las producciones de las décadas del sesenta y sus prolongaciones en los setenta, aunque ambas se inscribirían en una genealogía que implica dos modos diferentes de leer la dicotomía arte/vida, una de las tensiones en las estéticas de las vanguardias históricas. Una de ellas, iniciada en los años cincuenta en torno de la famosa revista Poesía Buenos Aires, dirigida por Raúl Gustavo Aguirre, emerge como consecuencia, principalmente, del procesamiento de la vanguardia francesa [especialmente el surrealismo] y podría ser caracterizada como trascendentalismo poético [Calabrese: 2001 y 2002], un aspecto de la ideología del arte que, representado en plenitud por los poetas llamados "malditos", concibe a la poesía como un modo de vida y al poeta como vate, un ser singular, que se constituye en la poesía misma y que atisba un universo diferente al de la cotidianeidad. Mientras que la segunda de las líneas mencionadas, -surgida entre 1955, con "El solicitante descolocado" de Leónidas Lamborghini y prolongada hasta los '70- conocida como la de los "sesentistas", se instaura en polémica con la índole gratuita y estetizante del arte. Se trata de aproximar el texto a lo que se denominaba el contexto aludiendo a lo histórico-social; para ello se intenta crear un imaginario que establezca una continuidad entre la escritura y un determinado modo de ver el mundo; la literatura, inscripta así en el imperativo sartreano, debe identificarse con la praxis política y con los discursos sociales de procedencia referencial [Dalmaroni: 1993 y 1998]. Ingresan, así, elementos procedentes de la cultura popular [por ejemplo, el tango] y las jergas urbanas que construyen un simulacro de oralidad, como materiales a inscribir en la poesía, enfatizando su índole "antiliteraria": tales elementos, al desplazarse de su contexto de procedencia, generan un efecto de extrañamiento, apto para promover una estimulación de la conciencia crítica y develar los ideologemas vigentes. En este contexto, se trata de problematizar la generalización de esta periodización dicotómica, mediante el estudio de las obras de los tres poetas mencionados, instaladas en un espacio de cruce e hibridaciones entre estos mandatos y la vertiente experimental o más intelectual, por lo que no responderían a los rasgos dominantes que permitirían inscribirlos en uno u otro extremo del campo diseñado.

Convergencias y divergencias respecto de las poéticas de la década del '60 en tres proyectos de escritura : César Fernández Moreno, Joaquín Giannuzzi y Alfredo Veiravé

La crítica especializada reconoce dos líneas dominantes en el campo intelectual argentino a partir de las producciones de las décadas del sesenta y sus prolongaciones en los setenta, aunque ambas se inscribirían en una genealogía que implica dos modos diferentes de leer la dicotomía arte/vida, una de las tensiones en las estéticas de las vanguardias históricas. Una de ellas, iniciada en los años cincuenta en torno de la famosa revista Poesía Buenos Aires, dirigida por Raúl Gustavo Aguirre, emerge como consecuencia, principalmente, del procesamiento de la vanguardia francesa [especialmente el surrealismo] y podría ser caracterizada como trascendentalismo poético [Calabrese: 2001 y 2002], un aspecto de la ideología del arte que, representado en plenitud por los poetas llamados "malditos", concibe a la poesía como un modo de vida y al poeta como vate, un ser singular, que se constituye en la poesía misma y que atisba un universo diferente al de la cotidianeidad. Mientras que la segunda de las líneas mencionadas, -surgida entre 1955, con "El solicitante descolocado" de Leónidas Lamborghini y prolongada hasta los '70- conocida como la de los "sesentistas", se instaura en polémica con la índole gratuita y estetizante del arte. Se trata de aproximar el texto a lo que se denominaba el contexto aludiendo a lo histórico-social; para ello se intenta crear un imaginario que establezca una continuidad entre la escritura y un determinado modo de ver el mundo; la literatura, inscripta así en el imperativo sartreano, debe identificarse con la praxis política y con los discursos sociales de procedencia referencial [Dalmaroni: 1993 y 1998]. Ingresan, así, elementos procedentes de la cultura popular [por ejemplo, el tango] y las jergas urbanas que construyen un simulacro de oralidad, como materiales a inscribir en la poesía, enfatizando su índole "antiliteraria": tales elementos, al desplazarse de su contexto de procedencia, generan un efecto de extrañamiento, apto para promover una estimulación de la conciencia crítica y develar los ideologemas vigentes. En este contexto, se trata de problematizar la generalización de esta periodización dicotómica, mediante el estudio de las obras de los tres poetas mencionados, instaladas en un espacio de cruce e hibridaciones entre estos mandatos y la vertiente experimental o más intelectual, por lo que no responderían a los rasgos dominantes que permitirían inscribirlos en uno u otro extremo del campo diseñado.

Convergencias y divergencias respecto de las poéticas de la década del '60 en tres proyectos de escritura : César Fernández Moreno, Joaquín Giannuzzi y Alfredo Veiravé

La crítica especializada reconoce dos líneas dominantes en el campo intelectual argentino a partir de las producciones de las décadas del sesenta y sus prolongaciones en los setenta, aunque ambas se inscribirían en una genealogía que implica dos modos diferentes de leer la dicotomía arte/vida, una de las tensiones en las estéticas de las vanguardias históricas. Una de ellas, iniciada en los años cincuenta en torno de la famosa revista Poesía Buenos Aires, dirigida por Raúl Gustavo Aguirre, emerge como consecuencia, principalmente, del procesamiento de la vanguardia francesa [especialmente el surrealismo] y podría ser caracterizada como trascendentalismo poético [Calabrese: 2001 y 2002], un aspecto de la ideología del arte que, representado en plenitud por los poetas llamados "malditos", concibe a la poesía como un modo de vida y al poeta como vate, un ser singular, que se constituye en la poesía misma y que atisba un universo diferente al de la cotidianeidad. Mientras que la segunda de las líneas mencionadas, -surgida entre 1955, con "El solicitante descolocado" de Leónidas Lamborghini y prolongada hasta los '70- conocida como la de los "sesentistas", se instaura en polémica con la índole gratuita y estetizante del arte. Se trata de aproximar el texto a lo que se denominaba el contexto aludiendo a lo histórico-social; para ello se intenta crear un imaginario que establezca una continuidad entre la escritura y un determinado modo de ver el mundo; la literatura, inscripta así en el imperativo sartreano, debe identificarse con la praxis política y con los discursos sociales de procedencia referencial [Dalmaroni: 1993 y 1998]. Ingresan, así, elementos procedentes de la cultura popular [por ejemplo, el tango] y las jergas urbanas que construyen un simulacro de oralidad, como materiales a inscribir en la poesía, enfatizando su índole "antiliteraria": tales elementos, al desplazarse de su contexto de procedencia, generan un efecto de extrañamiento, apto para promover una estimulación de la conciencia crítica y develar los ideologemas vigentes. En este contexto, se trata de problematizar la generalización de esta periodización dicotómica, mediante el estudio de las obras de los tres poetas mencionados, instaladas en un espacio de cruce e hibridaciones entre estos mandatos y la vertiente experimental o más intelectual, por lo que no responderían a los rasgos dominantes que permitirían inscribirlos en uno u otro extremo del campo diseñado.