Nutritional status of Ugandan women living with HIV/AIDS : anthropometry and body composition assessment

Human immunodeficiency virus (HIV) that leads to acquired immune deficiency syndrome (AIDs) reduces immune function, resulting in opportunistic infections and later death. Use of antiretroviral therapy (ART) increases chances of survival, however, with some concerns regarding fat re-distribution (lipodystrophy) which may encompass subcutaneous fat loss (lipoatrophy) and/or fat accumulation (lipohypertrophy), in the same individual. This problem has been linked to Antiretroviral drugs (ARVs), majorly, in the class of protease inhibitors (PIs), in addition to older age and being female. An additional concern is that the problem exists together with the metabolic syndrome, even when nutritional status/ body composition, and lipodystrophy/metabolic syndrome are unclear in Uganda where the use of ARVs is on the increase. In line with the literature, the overall aim of the study was to assess physical characteristics of HIV-infected patients using a comprehensive anthropometric protocol and to predict body composition based on these measurements and other standardised techniques. The other aim was to establish the existence of lipodystrophy, the metabolic syndrome, andassociated risk factors. Thus, three studies were conducted on 211 (88 ART-naïve) HIV-infected, 15-49 year-old women, using a cross-sectional approach, together with a qualitative study of secondary information on patient HIV and medication status. In addition, face-to-face interviews were used to extract information concerning morphological experiences and life style. The study revealed that participants were on average 34.1±7.65 years old, had lived 4.63±4.78 years with HIV infection and had spent 2.8±1.9 years receiving ARVs. Only 8.1% of participants were receiving PIs and 26% of those receiving ART had ever changed drug regimen, 15.5% of whom changed drugs due to lipodystrophy. Study 1 hypothesised that the mean nutritional status and predicted percent body fat values of study participants was within acceptable ranges; different for participants receiving ARVs and the HIV-infected ART-naïve participants and that percent body fat estimated by anthropometric measures (BMI and skinfold thickness) and the BIA technique was not different from that predicted by the deuterium oxide dilution technique. Using the Body Mass Index (BMI), 7.1% of patients were underweight (<18.5 kg/m2) and 46.4% were overweight/obese (≥25.0 kg/m2). Based on waist circumference (WC), approximately 40% of the cohort was characterized as centrally obese. Moreover, the deuterium dilution technique showed that there was no between-group difference in the total body water (TBW), fat mass (FM) and fat-free mass (FFM). However, the technique was the only approach to predict a between-group difference in percent body fat (p = .045), but, with a very small effect (0.021). Older age (β = 0.430, se = 0.089, p = .000), time spent receiving ARVs (β = 0.972, se = 0.089, p = .006), time with the infection (β = 0.551, se = 0.089, p = .000) and receiving ARVs (β = 2.940, se = 1.441, p = .043) were independently associated with percent body fat. Older age was the greatest single predictor of body fat. Furthermore, BMI gave better information than weight alone could; in that, mean percentage body fat per unit BMI (N = 192) was significantly higher in patients receiving treatment (1.11±0.31) vs. the exposed group (0.99±0.38, p = .025). For the assessment of obesity, percent fat measures did not greatly alter the accuracy of BMI as a measure for classifying individuals into the broad categories of underweight, normal and overweight. Briefly, Study 1 revealed that there were more overweight/obese participants than in the general Ugandan population, the problem was associated with ART status and that BMI broader classification categories were maintained when compared with the gold standard technique. Study 2 hypothesized that the presence of lipodystrophy in participants receiving ARVs was not different from that of HIV-infected ART-naïve participants. Results showed that 112 (53.1%) patients had experienced at least one morphological alteration including lipohypertrophy (7.6%), lipoatrophy (10.9%), and mixed alterations (34.6%). The majority of these subjects (90%) were receiving ARVs; in fact, all patients receiving PIs reported lipodystrophy. Period spent receiving ARVs (t209 = 6.739, p = .000), being on ART (χ2 = 94.482, p = .000), receiving PIs (Fisher’s exact χ2 = 113.591, p = .000), recent T4 count (CD4 counts) (t207 = 3.694, p = .000), time with HIV (t125 = 1.915, p = .045), as well as older age (t209 = 2.013, p = .045) were independently associated with lipodystrophy. Receiving ARVs was the greatest predictor of lipodystrophy (p = .000). In other analysis, aside from skinfolds at the subscapular (p = .004), there were no differences with the rest of the skinfold sites and the circumferences between participants with lipodystrophy and those without the problem. Similarly, there was no difference in Waist: Hip ratio (WHR) (p = .186) and Waist: Height ratio (WHtR) (p = .257) among participants with lipodystrophy and those without the problem. Further examination showed that none of the 4.1% patients receiving stavudine (d4T) did experience lipoatrophy. However, 17.9% of patients receiving EFV, a non-nucleoside reverse transcriptase inhibitor (NNRTI) had lipoatrophy. Study 2 findings showed that presence of lipodystrophy in participants receiving ARVs was in fact far higher than that of HIV-infected ART-naïve participants. A final hypothesis was that the prevalence of the metabolic syndrome in participants receiving ARVs was not different from that of HIV-infected ART-naïve participants. Moreover, data showed that many patients (69.2%) lived with at least one feature of the metabolic syndrome based on International Diabetic Federation (IDF, 2006) definition. However, there was no single anthropometric predictor of components of the syndrome, thus, the best anthropometric predictor varied as the component varied. The metabolic syndrome was diagnosed in 15.2% of the subjects, lower than commonly reported in this population, and was similar between the medicated and the exposed groups (χ 21 = 0.018, p = .893). Moreover, the syndrome was associated with older age (p = .031) and percent body fat (p = .012). In addition, participants with the syndrome were heavier according to BMI (p = .000), larger at the waist (p = .000) and abdomen (p = .000), and were at central obesity risk even when hip circumference (p = .000) and height (p = .000) were accounted for. In spite of those associations, results showed that the period with disease (p = .13), CD4 counts (p = .836), receiving ART (p = .442) or PIs (p = .678) were not associated with the metabolic syndrome. While the prevalence of the syndrome was highest amongst the older, larger and fatter participants, WC was the best predictor of the metabolic syndrome (p = .001). Another novel finding was that participants with the metabolic syndrome had greater arm muscle circumference (AMC) (p = .000) and arm muscle area (AMA) (p = .000), but the former was most influential. Accordingly, the easiest and cheapest indicator to assess risk in this study sample was WC should routine laboratory services not be feasible. In addition, the final study illustrated that the prevalence of the metabolic syndrome in participants receiving ARVs was not different from that of HIV-infected ART-naïve participants.

Cost effectiveness of patient education for the prevention of falls in hospital : economic evaluation from a randomized controlled trial

Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. Conclusions This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service.

Review : "For the Term of His Natural Life" -- Norman Dawn

Synopsis and review of For the Term of His Natural Life (Norman Dawn, 1927). Includes cast and credits. For the Term of His Natural Life was one of the last Australian silent films, and also one of the most significant in the history of Australian cinema. At the time of its production, controversy raged over its depiction of convict life, its scale and cost (which was reported to be around 50,000 pounds at a time when most Australian films had budgets of less than 2,000 pounds1) and the fact that the director, several of the crew and the leading cast members were American. Australasian Films launched a publicity campaign of unprecedented scale to counter opposition to the film’s subject matter and the charge that they were “seeking to make capital out of the drab and sordid days of Australia”.2 The film’s expense was turned into a virtue: hundreds of unemployed men were used as extras, while the film also provided work for many within the Australian film industry and, according to Australasian, enabled the establishment of new production companies. The American imports who earlier had been accused of being “party to the slaughtering” of the Australian film industry, were feted for their artistic contributions, and the concerns raised in federal parliament about an American “invasion” were deflected by claims about what the local industry could learn from those with Hollywood experience.3 The publicity campaign was successful, as the film proved enormously popular at the Australian box office in its initial run. But the coming of sound film in 1928 had a considerable impact on audiences for silent films like For the Term, and its early local success was not repeated in subsequent seasons or in overseas markets...

Developing an adaptive radiotherapy technique for virally mediated head and neck cancer

Purpose Virally mediated head and neck cancers (VMHNC) often present with nodal involvement and are highly radioresponsive, meaning that treatment plan adaptation during radiotherapy (RT) in a subset of patients is required. We sought to determine potential risk profiles and a corresponding adaptive treatment strategy for these patients. Methodology 121 patients with virally mediated, node positive nasopharyngeal (Epstein Barr Virus positive) or oropharyngeal (Human Papillomavirus positive) cancers, receiving curative intent RT were reviewed. The type, frequency and timing of adaptive interventions, including source-to-skin distance (SSD) corrections, re-scanning and re-planning, were evaluated. Patients were reviewed based on the maximum size of the dominant node to assess the need for plan adaptation. Results Forty-six patients (38%) required plan adaptation during treatment. The median fraction at which the adaptive intervention occurred was 26 for SSD corrections and 22 for re-planning CTs. A trend toward 3 risk profile groupings was discovered: 1) Low risk with minimal need (< 10%) for adaptive intervention (dominant pre-treatment nodal size of ≤ 35 mm), 2) Intermediate risk with possible need (< 20%) for adaptive intervention (dominant pre-treatment nodal size of 36 mm – 45 mm) and 3) High-risk with increased likelihood (> 50%) for adaptive intervention (dominant pre-treatment nodal size of ≥ 46 mm). Conclusion In this study, patients with VMHNC and a maximum dominant nodal size of > 46 mm were identified at a higher risk of requiring re-planning during a course of definitive RT. Findings will be tested in a future prospective adaptive RT study.

Determinants of drink-driving and association between drink-driving and road traffic fatalities in Ghana

Aim The objective is to establish determinants of drink-driving and its association with traffic crashes in Ghana. Methods A multivariable logistic regression was used to establish significant determinants of drink-driving and a bivariate logistic regression to establish the association between drink–driving and road traffic crashes in Ghana. Results In total, 2,736 motorists were randomly stopped for breath testing of whom 8.7% tested positive for alcohol. Among the total participants, 5.5% exceeded the legal BAC limit of 0.08%. Formal education is associated with a reduced likelihood of drink-driving compared with drivers without formal education. The propensity to drink-drive is 1.8 times higher among illiterate drivers compared with drivers with basic education. Young adult drivers also recorded elevated likelihoods for driving under alcohol impairment compared with adult drivers. The odds of drink-driving among truck drivers is OR=1.81, (95% CI=1.16 to 2.82) and two wheeler riders is OR=1.41, (95% CI=0.47 to 4.28) compared with car drivers. Contrary to general perception, commercial car drivers have a significant reduced likelihood of 41%, OR=0.59, (95% CI=0.38 to 0.92) compared with the private car driver. Bivariate analysis conducted showed a significant association between the proportion of drivers exceeding the legal BAC limit and road traffic fatalities, p<0.001. The model predicts a 1% increase in the proportion of drivers exceeding the legal BAC to be associated with a 4% increase in road traffic fatalities, 95% CI= 3% to 5% and vice versa. Conclusion A positive and significant association between roadside alcohol prevalence and road traffic fatality has been established. Scaling up roadside breath test, determining standard drink and disseminating to the populace and formulating policies targeting the youth such as increasing minimum legal drinking age and reduced legal BAC limit for the youth and novice drivers might improve drink-driving related crashes in Ghana.

Role of the apolipoprotein E and catechol-O-methyltransferase genes in prospective and retrospective memory traits

Human memory is a complex neurocognitive process. By combining psychological and molecular genetics expertise, we examined the APOE ε4 allele, a known risk factor for Alzheimer's disease, and the COMT Val 158 polymorphism, previously implicated in schizophrenia, for association with lowered memory functioning in healthy adults. To assess memory type we used a range of memory tests of both retrospective and prospective memory. Genotypes were determined using RFLP analysis and compared with mean memory scores using univariate ANOVAs. Despite a modest sample size (n=197), our study found a significant effect of the APOE ε4 polymorphism in prospective memory. Supporting our hypothesis, a significant difference was demonstrated between genotype groups for means of the Comprehensive Assessment of Prospective Memory total score (p=0.036; ε4 alleles=1.99; all other alleles=1.86). In addition, we demonstrate a significant interactive effect between the APOE ε4 and COMT polymorphisms in semantic memory. This is the first study to investigate both APOE and COMT genotypes in relation to memory in non-pathological adults and provides important information regarding the effect of genetic determinants on human memory.

Labour market institutions and the gender wage gap in Britain and Australia, 1973–90

The importance of wage structure is frequently interpreted as indirect evidence of the role played by labour market institutions. The current paper follows in this tradition, examining the role of wage structure in explaining the trend in the gender wage gap over the period 1973–91 for both Australia and the UK. The focus is upon whether changes in wage structure (and associated gender wage gap) both across country and over time are compatible with institutional explanations. Combining comparisons both cross-country and over time yields a more stringent, albeit indirect, test of the role of institutions.

Association of a vitamin D receptor polymorphism with sporadic breast cancer development

Breast cancer is the leading cause of cancer death among Australian women and its incidence is annually increasing. Genetic factors are involved in the complex etiology of breast cancer. The seco-steroid hormone, 1.25 dihydroxy vitamin D3 can influence breast cancer cell growth in vitro. A number of studies have reported correlations between vitamin D receptor (VDR) gene polymorphisms and several diseases including prostate cancer and osteoporosis. In breast cancer, low vitamin D levels in serum are correlated with disease progression and bone metastases, a situation also noted in prostate cancer and suggesting the involvement of the VDR. In our study, 2 restriction fragment length polymorphisms (RFLP) in the 3' region (detected by Apa1 and Taq1) and an initiation codon variant in the 5' end of the VDR gene (detected by Fok1) were tested for association with breast cancer risk in 135 females with sporadic breast cancer and 110 cancer-free female controls. Allele frequencies of the 3' Apa1 polymorphism showed a significant association (p = 0.016; OR = 1.56, 95% CI = 1.09-2.24) while the Taq1 RFLP showed a similar trend (p = 0.053; OR = 1.45, 95% CI = 1.00-2.00). Allele frequencies of the Fok1 polymorphism were not significantly different (p = 0.97; OR = 0.99, 95% CI = 0.69-1.43) in the study population. Our results suggest that specific alleles of the VDR gene located near the 3' region may identify an increased risk for breast cancer and justify further investigation of the role of VDR in breast cancer.

To what extent is the Mayer and Salovey (1997) model of emotional intelligence a useful predictor of leadership style and perceived leadership outcomes in Australian educational institutions?

Researchers have found that transformational leadership is related to positive outcomes in educational institutions. Hence, it is important to explore constructs that may predict leadership style in order to identify potential transformational leaders in assessment and selection procedures. Several studies in non-educational settings have found that emotional intelligence is a useful predictor of transformational leadership, but these studies have generally lacked methodological rigor and contextual relevance. This project, set in Australian educational institutions, employed a more rigorous methodology to answer the question: to what extent is the Mayer and Salovey (1997) model of emotional intelligence a useful predictor of leadership style and perceived leadership outcomes? The project was designed to move research in the field forward by using valid and reliable instruments, controlling for other predictors, obtaining an adequately sized sample of current leaders and collecting multiple ratings of their leadership behaviours. The study (N = 144 leaders and 432 raters) results indicated that emotional intelligence was not a useful predictor of leadership style and perceived leadership outcomes. In contrast, several of the other predictors in the study were found to predict leadership style.

Blog research : the 'computational turn' [Blogforschung: Der 'Computational Turn']

ForscherInnen aus Sozial- und Geisteswissenschaften interessieren sich seit nunmehr einem Jahrzehnt für Blogs, Online-Tagebücher und Online-Journale. Auch wenn die Zuwachsrate der Blogosphäre seit der Blütezeit des Bloggens in den 2000ern stagniert, bleiben Blogs doch eines der bedeutendsten Genres der internetgestützten Kommunikation. Tatsächlich ist nach der Massenabwanderung zu Facebook, Twitter und anderen erst in jüngerer Zeit entstandenen Kommunikationsmitteln eine etwas kleinere, aber umso stärker etablierte Blogosphäre von engagierten und eingeschworenen Teilnehmenden übriggeblieben. Blogs werden mittlerweile als Teil einer institutionellen, persönlichen und Gruppen-Kommunikationstrategie akzeptiert. In Stil und Inhalt liegen sie zwischen den statischeren Informationen auf konventionellen Websites und den ständig aktualisierten Facebook- und Twitter-Newsfeeds. Blogs ermöglichen es ihren AutorInnen (und deren KommentatorInnen), bestimmte Themen im Umfang von einigen hundert bis zu einigen tausend Wörtern zu durchdenken, in kürzeren Posts ins Detail zu gehen und ggf. intensiver durchdachte Texte anderswo zu publizieren. Zudem sind sie auch ein sehr flexibles Medium: Bilder, Audio-, Video- sowie andere Materialien können mühelos eingefügt werden - und natürlich auch das grundlegende Instrument des Bloggens: Hyperlinks.

An activity and resource advisory system for manufacturing process chains selection at the early stage of product development

Designers need to consider both the functional and production process requirements at the early stage of product development. A variety of the research works found in the literature has been proposed to assist designers in selecting the most viable manufacturing process chain. However, they do not provide any assistance for designers to evaluate the processes according to the particular circumstances of their company. This paper describes a framework of an Activity and Resource Advisory System (ARAS) that generates advice about the required activities and the possible resources for various manufacturing process chains. The system provides more insight, more flexibility, and a more holistic and suitable approach for designers to evaluate and then select the most viable manufacturing process chain at the early stage of product development.

How to increase the accuracy of analysis and reduce the computational time in ANSYS in the case of deformation study of orthopedic bone plates

Currently, finite element analyses are usually done by means of commercial software tools. Accuracy of analysis and computational time are two important factors in efficiency of these tools. This paper studies the effective parameters in computational time and accuracy of finite element analyses performed by ANSYS and provides the guidelines for the users of this software whenever they us this software for study on deformation of orthopedic bone plates or study on similar cases. It is not a fundamental scientific study and only shares the findings of the authors about structural analysis by means of ANSYS workbench. It gives an idea to the readers about improving the performance of the software and avoiding the traps. The solutions provided in this paper are not the only possible solutions of the problems and in similar cases there are other solutions which are not given in this paper. The parameters of solution method, material model, geometric model, mesh configuration, number of the analysis steps, program controlled parameters and computer settings are discussed through thoroughly in this paper.

Phase evolution of the quenched melt of YBa2Cu3O7-y with 20 mol% Y2BaCuO5 additions

Samples of YBa2Cu3O7-y + 20 mol% Y2BaCuO5 have been melt processed and quenched from temperatures ranging from 975 to 1100°C. The microstructure of the samples have been characterized via a combination of x-ray diffractometry, optical microscopy, scanning electron microscopy, energy dispersive x-ray spectrometry and wavelength dispersive x-ray spectrometry. BaCuO2 (BC1) and BaCu2O2 (BC2) crystallize from the melt of samples quenched from temperatures between 985 and 1100°C in air. The average yttrium content differs for BC1 and BC2, and it is 4.3 and 5.1 at.%, respectively. Holding times of 20 hours at temperatures above or equal to 1040°C give rise to a dendritic pattern of BC1 surrounded by BC2. The complex changes of the nature of the melt as a function of temperature and time are likely to play a significant role in the mechanism of melt texturing.

Peripheral refraction patterns out to large field angles

Purpose To investigate hyperopic shifts and the oblique (or 45-degree/135-degree) component of astigmatism at large angles in the horizontal visual field using the Hartmann-Shack technique. Methods The adult participants consisted of 6 hypermetropes, 13 emmetropes and 11 myopes. Measurements were made with a modified COAS-HD Hartmann-Shack aberrometer across T60 degrees along the horizontal visual field in 5-degree steps. Eyes were dilated with 1% cyclopentolate. Peripheral refraction was estimated as mean spherical (or spherical equivalent) refraction, with/against the rule of astigmatism and oblique astigmatism components, and as horizontal and vertical refraction components based on 3-mm major diameter elliptical pupils. Results Thirty percent of eyes showed a pattern that was a combination of type IV and type I patterns of Rempt et al. (Rempt F, Hoogerheide J, Hoogenboom WP. Peripheral retinoscopy and the skiagram. Ophthalmologica 1971;162:1Y10), which shows the characteristics of type IV (relative hypermetropia along the vertical meridian and relative myopia along the horizontal meridian) out to an angle of between 40 and 50 degrees before behaving like type I (both meridians show relative hypermetropia). We classified this pattern as type IV/I. Seven of 13 emmetropes had this pattern. As a group, there was no significant variation of the oblique component of astigmatism with angle, but about one-half of the eyes showed significant positive slopes (more positive or less negative values in the nasal field than in the temporal field) and one-fourth showed significant negative slopes. Conclusions It is often considered that a pattern of relative peripheral hypermetropia predisposes to the development of myopia. In this context, the finding of a considerable portion of emmetropes with the IV/I pattern suggests that it is unlikely that refraction at visual field angles beyond 40 degrees from fixation contributes to myopia development.

Retaining rural and remote area nurses : The Queensland, Australia experience

Because higher-than-average turnover rates for nurses who work in remote and rural areas are the norm, the authors conducted a study to identify professional and personal factors that influenced rural nurses’ decisions to resign. Using a mail survey, the authors gathered qualitative and quantitative data from nurses who had resigned from rural and remote areas in Queensland, Australia. Their findings, categorized into professional and rural influences, highlight the importance of work force planning strategies that capitalize on the positive aspects of rural and remote area practice, to retain nurses in nonmetropolitan areas.