Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis

Objectives  To assess the proportion of patients lost to programme (died, lost to follow-up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. Methods  Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. Results  Twenty-nine studies from sub-Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60-84) had a CD4 cell count measured, 40 (95% CI 26-55) were eligible for ART and 25 (95% CI 13-37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25%vs. 54%, P < 0.0001), but eligible patients were more likely to die (11%vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status and in recent time periods. Conclusions  Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.

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.

Recommendations for sex/gender neuroimaging research: Key principles and implications for research design, analysis and interpretation

Neuroimaging (NI) technologies are having increasing impact in the study of complex cognitive and social processes. In this emerging field of social cognitive neuroscience, a central goal should be to increase the understanding of the interaction between the neurobiology of the individual and the environment in which humans develop and function. The study of sex/gender is often a focus for NI research, and may be motivated by a desire to better understand general developmental principles, mental health problems that show female-male disparities, and gendered differences in society. In order to ensure the maximum possible contribution of NI research to these goals, we draw attention to four key principles—overlap, mosaicism, contingency and entanglement—that have emerged from sex/gender research and that should inform NI research design, analysis and interpretation. We discuss the implications of these principles in the form of constructive guidelines and suggestions for researchers, editors, reviewers and science communicators.

Pre-therapy inflammation and coagulation activation and long-term CD4 count responses to the initiation of antiretroviral therapy

OBJECTIVES Pre-antiretroviral therapy (ART) inflammation and coagulation activation predict clinical outcomes in HIV-positive individuals. We assessed whether pre-ART inflammatory marker levels predicted the CD4 count response to ART. METHODS Analyses were based on data from the Strategic Management of Antiretroviral Therapy (SMART) trial, an international trial evaluating continuous vs. interrupted ART, and the Flexible Initial Retrovirus Suppressive Therapies (FIRST) trial, evaluating three first-line ART regimens with at least two drug classes. For this analysis, participants had to be ART-naïve or off ART at randomization and (re)starting ART and have C-reactive protein (CRP), interleukin-6 (IL-6) and D-dimer measured pre-ART. Using random effects linear models, we assessed the association between each of the biomarker levels, categorized as quartiles, and change in CD4 count from ART initiation to 24 months post-ART. Analyses adjusted for CD4 count at ART initiation (baseline), study arm, follow-up time and other known confounders. RESULTS Overall, 1084 individuals [659 from SMART (26% ART naïve) and 425 from FIRST] met the eligibility criteria, providing 8264 CD4 count measurements. Seventy-five per cent of individuals were male with the mean age of 42 years. The median (interquartile range) baseline CD4 counts were 416 (350-530) and 100 (22-300) cells/μL in SMART and FIRST, respectively. All of the biomarkers were inversely associated with baseline CD4 count in FIRST but not in SMART. In adjusted models, there was no clear relationship between changing biomarker levels and mean change in CD4 count post-ART (P for trend: CRP, P = 0.97; IL-6, P = 0.25; and D-dimer, P = 0.29). CONCLUSIONS Pre-ART inflammation and coagulation activation do not predict CD4 count response to ART and appear to influence the risk of clinical outcomes through other mechanisms than blunting long-term CD4 count gain.

La aportación de la Península Ibérica a la tecnología naval analizada a través de la interpretación de los documentos y la reproducción de los buques descritos en ellos (1570-1620)

El período de la Historia comprendido entre 1570 y 1620 nos ha dejado un importante conjunto de documentos relacionados con la construcción naval en la Península Ibérica. En una época convulsa en la que los reinos de España y Portugal se aglutinaron bajo una misma Corona, surgen una serie de manuscritos, libros y leyes que reflejan la creciente preocupación de la sociedad por el tema naval. Entre sus páginas encontramos las descripciones del proceso constructivo de los buques que sus autores consideraban más significativos para las demandas que se planteaban en ese momento. Este proceso que combinaba generación de formas y construcción del buque provenía de una secular tradición nacida en el Mediterráneo. Mediante reglas geométricas sencillas, el constructor naval trazaba las secciones centrales y el perfil de la nao, quedando los extremos de la misma (hasta más de la mitad de la eslora) a su buen hacer y experiencia. Las herramientas informáticas de generación de superficies mediante NURBs (Non- Uniform Rational B-spline) permiten reconstruir las formas de los navíos reproduciendo con fiabilidad las carenas de los mismos a partir de los documentos de la época. Mediante un estudio detallado de interpretación de los textos y transcribiendo los procesos, llegamos a obtener con un buen grado de precisión las carenas de los buques descritos en sus páginas. A partir de ahí y mediante el análisis cualitativo y cuantitativo de los parámetros obtenidos es posible valorar si las soluciones representadas por los barcos respondían a las preguntas planteadas por sus autores , la influencia de factores externos a la construcción naval tales como las regulaciones del Estado o identificar su relación con el germen y la expansión de la teoría que ha determinado los efectos de la Ciencia en la Arquitectura Naval. Comenzando por la nao veneciana de 1550, heredera de la secular tradición constructiva mediterránea, hasta llegar a las Reales Ordenanzas promulgadas en 1618, se reproducen hasta nueve carenas a partir de otros tantos documentos, se dibujan sus planos de formas y se exportan para su análisis hidrostático. El trabajo requiere la realización de otros estudios en paralelo necesarios para entender aquellos factores que formaron parte del desarrollo tecnológico naval como son, las unidades de medida en uso en los astilleros, los distintos sistemas de arqueo impuestos por la Corona y la representación de los diferentes instrumentos geométricos de modificación de los parámetros de diseño. A lo largo del trabajo se dan respuesta a interrogantes planteados por la arqueología en relación con el desarrollo de la arquitectura naval poniendo en evidencia que durante este período quedaron establecidos los fundamentos teórico-prácticos de lo que más adelante se convirtió en la ciencia de la ingeniería naval y se plantean nuevos retos para aquellos que deseen continuar la apasionante tarea de la investigación científica de nuestra historia. ABSTRACT The period of the History comprised between 1570 and 1620 has left an important set of shipbuilding documents in the Iberian Peninsula. In a turbulent time in which the kingdoms of Spain and Portugal were ruled under the same Crown, manuscripts, books and laws that reflect the growing concern of society for the naval theme arose. We found among their pages shipbuilding process descriptions of the more relevant vessels that responded to claims that arose at that time. This process brought together hull generation and shipbuilding and came from a secular tradition born in the Mediterranean. By means of simple geometric rules, the shipbuilder traced the central sections and profile of the ship, leaving the ends thereof (almost half of the length) to its good performance and experience. 3D computer modelling software by NURBs (Non-Uniform Rational B-spline) surfaces helps to reconstruct ships hulls from contemporary documents. Through a detailed texts interpretation and transcription processes, we manage to reach with a good degree of accuracy the ship hulls described in its pages. From there and through qualitative and quantitative analysis of the parameters obtained we can assess whether the solutions represented by ships gave response to the questions raised by the authors, the influence of external factors such as shipbuilding state regulations or identify their relationship to the origin and expansion of the theory that has determined the effects of Science in Naval Architecture. From the 1550 Venetian nao, inheritor of the secular Mediterranean building tradition, to the Royal Ordinances enacted in 1618, as nine hulls are reproduced, their line drawings are traced and exported for analysis hydrostatic. Further studies are needed to understand the factors that were part of shipbuilding technology development as the units of measure in use in shipyards, the different official regulations for calculating ship tonnage and the different geometric instruments to amend the design parameters. The work gives response to questions raised by archaeology in relation to the development of naval architecture highlighting that during this period were established the theoretical and practical foundations of what later became the science of naval engineering and raising new challenges for those wishing to continue the exciting task of scientific research of our History.

Made in God's Image! - What Does It Mean? Science and Religion in Conversation

How can we best interpret the traditional Christian affirmation that human beings are made in God's image in light of contact and dialogue between religion and science? And what, if any, are the environmental implications of this conversation between the two?

John La Farge as collector of Japanese art : motivations and reflections

Throughout his lifetime, American artist John La Farge (1835-1910) amassed an enormous collection of art and books. La Farge’s study of art and culture encompassed several genres and aesthetic elements. La Farge has been credited as the first American artist — even prior to James Abbott McNeill Whistler (1834-1903)— to integrate visual elements and cultural awareness of the Far East within his own Western-trained art. Although many scholars have studied La Farge’s art and life from various perspectives, including his interest in Asian art, the object of the present study is solely focused on La Farge’s collecting of Japanese art.

Promoting interculturalism through art education : a case study Portugal and Latvia

This study examines art student’s awareness, understanding and practices of intercultural art education in higher institution of art. Specifically, the research focused on Art Academy of Latvia, Riga. The purpose was to promote “interculturalism’’ among students and to acquaint them with the knowledge and skills of developing and reflecting on their cultural values and that of others’. For 10 weeks, 7 students in the Art Academy of Latvia explored the Traditional African Ceramics. My research included data gathered from student questionnaires, class discussions, interviews, observations, student artwork and photographs from their personal activities. I likewise took note of the students’ practical works and their approach to African-based ceramics. First, in literature review, I discuss my purpose of study, why the study is important, limitations, statements of problem, and further research. Secondly, I examine culture and paradigms of cultures, comprehensive context of the African history and traditions of the African ceramics, the importance of intercultural art education. Then, I describe how the case study in Latvia was carried out among 7 participants’ who are students from 2nd year – masters’ level. The case study involved 7 students from the department of graphics, glass, ceramics and painting with the aim of promoting intercultural learning among art students. The case study reveals participants’ attitude towards intercultural education and reveal the importance of intercultural education in higher institutions of art as well as other institutions of learning. Although the participants were positive attitude towards other culture, the study reveals that creating awareness through intercultural art and exposing students to other culture enhances their creativity ability to explore other culture and they are more likely to be opened in sharing their experiences and their cultural perspective. Experiencing culture based- art create awareness of other cultures

Patenting Systems, Patentable Subject Matter, and Prior Art

The International School of Solid State Physics presented the 56th Course"Materials for Renewable Energy” in Erice (Italy), from July 18th to 28th 2012. This course was sponsored by the Italian Ministry of Education, University and Scientific Research, the Materials Research Society and the European Materials Research Society. The event was hosted at the "Ettore Majorana Foundation and Centre for Scientific Culture”. The school reviewed critical materials issues for the production and storage of renewable and sustainable energy. The aim of the School was to present the state-of-the-art and future perspectives in this critical area. It was to bring together the international community of students, young scientists, and experts in a unique atmosphere for reciprocal benefits in terms of enthusiasm, knowledge and new ideas.

The Pentateuch in contrast with the science and moral sense of our age.

Each part has separate t.-p.: part 6 has title: The Pentateuch and book of Joshua in face of the science and moral sense of our age.

On science and revelation. Being the presidential address delivered at the annual meeting of the Victoria Institute.

On title page: Author's copy.