Factors associated with the retention of HIV-infected children in care in Botswana

Lost to follow up (LTFU) in the care and treatment of HIV/AIDS represents a particularly problematic aspect when evaluating the success of treatment programs. Identifying modifiable factors that lead to LTFU would be important if we are to design effective retention interventions. The purpose of this study was to identify the challenges faced by children seeking care and treatment at a large HIV Clinic in Botswana. In order to identify those factors, we used mixed methods from different sources of information available at the Baylor Clinic. The first method involved a case-control study through which we interviewed a select representation of children 1-18 years who, at some point in time, have attended clinic at Baylor Clinic in Gaborone, Botswana. We document this in detail using the first journal article. We defined LTFU as patients who had not attended clinic for more than 6 months at the onset of the study; the comparison group was recruited from among those who have attended clinic at any point in the 6 months leading to the start of study. Factors were compared between the cases and controls. The second methodology involved conducting in-depth interviews with health providers to elicit their opinions and experiences dealing with patients at the at the Baylor clinic in general and the LTFU patients in particular. We document this methodology and its findings in the second journal article. ^ We found that most patients that are LTFU failed to engage with the clinic. Most of the LTFU made only one visit to the clinic (47.66%) as compared to less than 1% in the control group (P<0.01, 2-tailed Fisher's exact test). Among the interviewed patients, psychosocial factors such as stigma, religious beliefs, child rebellion and disclosure of HIV status concerns were characteristic of the LTFU population, but psychosocial issues were not cited among the comparison group. We also found that these psychosocial aspects of the patients point towards a bigger problem of mental health that needs to be addressed. Socioeconomic factors such as lack of transport, school-related activities and forgetting check-up dates were cited predominantly by the controls than cases. ^ From these findings, there is need to target interventions towards engaging pediatric patients at their initial clinic visit. Such interventions would focus on psychosocial support, as well as involving faith-based organizations in planning joint responses.^

El delito en Mendoza

En el contexto de la crisis socioeconómica que está sufriendo el país se advierte, en estos primeros años del siglo 21, tanto en las cifras oficiales como por la “insistencia" mediática, un crecimiento sostenido en la Argentina del total de delitos cometidos. Si se hace un poco de memoria se recordará que, por lo menos en Mendoza, el punto de inflexión en que la capital provincial pasó de ser la tranquila ciudad principal del oasis norte de la provincia, a una ciudad con las características de inseguridad y violencia propias de las grandes urbes tercermundistas (México D.F., Sao Paulo), parece ubicarse aproximadamente a mediados de la década del 1990. Las razones y el momento en que ocurren ciertas situaciones, como las crisis económicas o el aumento del delito, no se debe al azar y a cuestiones aleatorias. Las situaciones que se viven hoy día son efecto de otras que han sucedido en el pasado, reciente o remoto. Es el fin de las ciencias sociales darle un sentido a lo que de otra manera aparecería como caótico, buscando las causas que operan en el trasfondo y que determinan cómo suceden los fenómenos y cuándo. Si se acepta lo anterior resulta importante, entonces, estudiar desde una perspectiva sociológica las causas de la criminalidad y su aumento en la ciudad de Mendoza. Sólo de esta manera se podrá mejorar la comprensión del fenómeno, para actuar “técnicamente" sobre él desde las políticas de Estado y para predecir, desde las teorías criminológicas, el desarrollo futuro probable. Se parte de la idea de que uno de los grandes defectos de todos los partidos políticos argentinos, y de los gobiernos de turno, es la falta de acuerdo o de ideas para desarrollar e implementar políticas estratégicas de Estado a largo plazo. Se intentará que este trabajo, aunque se ocupe del tema concreto del delito en Mendoza, igual refleje la importancia dada a que existan políticas de Estado y de que éstas se basen sobre marcos conceptuales coherentes.

Normas y protocolos clínicos sobre el empleo del misoprostol en ginecología y obstetricia

SAAF/IPPF

Concentration of C2-C6 hydrocarbon gases in dry sediments of ODP Sites 180-1109 and 180-1115

Low molecular weight hydrocarbon (LMWH) distributions were examined in sediments from Sites 1109 and 1115 in the western Woodlark Basin using purge-trap thermal adsorption/desorption gas analysis. A number of different hydrocarbon components >C1, which were not detected during shipboard gas analysis, were detected at both sites using the purge-trap procedure. Concentrations of ethane, propane, and butane remained relatively low (<100 pmol/g) throughout Site 1109 and had no consistent trend with depth. In contrast, the longer-chain components increased in concentration with depth. Hexane concentrations rose to 716 pmol/g at the base of the site with a concomitant increase in both 2-methyl- and 3-methylpentane. At Site 1115, concentrations of ethane, propane, butane, and isobutylene + 1-butene remained low (<60 pmol/g) throughout the site and again had no consistent trend with depth. 2-Methylpentane, 3-methylpentane, and hexane concentrations had a subsurface maximum that coincided with sediments containing abundant plant-rich material. The LMWH downhole profiles plus low in situ temperatures suggest that the LMWH components were formed in situ by low-temperature biological processes. Purge-trap analysis has indicated the presence of some unexpected deep low-temperature bacterial reactions, which demonstrates that further analysis of LMWH may provide valuable information at future Ocean Drilling Program sites.

Sr-Nd isotopic analyses of sand-sized sediment from the San Francisco Bay coastal system

A diverse suite of geochemical tracers, including 87Sr/86Sr and 143Nd/144Nd isotope ratios, the rare earth elements (REEs), and select trace elements were used to determine sand-sized sediment provenance and transport pathways within the San Francisco Bay coastal system. This study complements a large interdisciplinary effort (Barnard et al., 2012) that seeks to better understand recent geomorphic change in a highly urbanized and dynamic estuarine-coastal setting. Sand-sized sediment provenance in this geologically complex system is important to estuarine resource managers and was assessed by examining the geographic distribution of this suite of geochemical tracers from the primary sources (fluvial and rock) throughout the bay, adjacent coast, and beaches. Due to their intrinsic geochemical nature, 143Nd/144Nd isotopic ratios provide the most resolved picture of where sediment in this system is likely sourced and how it moves through this estuarine system into the Pacific Ocean. For example, Nd isotopes confirm that the predominant source of sand-sized sediment to Suisun Bay, San Pablo Bay, and Central Bay is the Sierra Nevada Batholith via the Sacramento River, with lesser contributions from the Napa and San Joaquin Rivers. Isotopic ratios also reveal hot-spots of local sediment accumulation, such as the basalt and chert deposits around the Golden Gate Bridge and the high magnetite deposits of Ocean Beach. Sand-sized sediment that exits San Francisco Bay accumulates on the ebb-tidal delta and is in part conveyed southward by long-shore currents. Broadly, the geochemical tracers reveal a complex story of multiple sediment sources, dynamic intra-bay sediment mixing and reworking, and eventual dilution and transport by energetic marine processes. Combined geochemical results provide information on sediment movement into and through San Francisco Bay and further our understanding of how sustained anthropogenic activities which limit sediment inputs to the system (e.g., dike and dam construction) as well as those which directly remove sediments from within the Bay, such as aggregate mining and dredging, can have long-lasting effects.