Outcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration

OBJECTIVES: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. DESIGN AND SETTING: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. SUBJECTS: ART-naive children (< or = 16 years) who commenced treatment with > or = 3 antiretroviral drugs before March 2008. OUTCOME MEASURES: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox proportional hazards models stratified by site. Immune status, virological suppression and growth were described in relation to duration of ART. RESULTS: The median (interquartile range) age of 6 078 children with 9 368 child-years of follow-up was 43 (15 - 83) months, with 29% being < 18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (< 400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Together with young age, all markers of disease severity (low weight-for-age z-score, high viral load, severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. CONCLUSIONS: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.

The changing values of children and preferences regarding family size in south Africa

This study extends the ongoing studies on values of children and intergenerational relations into an African context with the following key questions: To what extent can the structure of values of children (VOC) identified in previous studies be found in South Africa and what are women's preferences regarding the size of small, large, and ideal families? The sample consisted of three cohorts of Black South African women from the Limpopo Province. Factor analyses showed that the dimensions of VOC found in South Africa are a conglomeration of different values. Identified dimensions were Social/Emotional and Traditional/Utilitarian with respect to reasons for wanting children. Regarding reasons for not wanting children, Child as Source of Constraints and Constraints to Have a Child were identified. Intergenerational comparisons showed variations in the importance of value of children dimensions and in preferences regarding family size. Values of children of younger mothers were related to the number of children these women had and to their preferences regarding family size. The findings are discussed within the changing socio-political context of South Africa.

Globalized Antiquity: Uses and Perceptions of the Past in South Asia, Mesoamerica, and Europe

„Antike“ ist keine europäische Exklusivität: Das Buch zeigt, wie in Südasien, Mesoamerika und Europa je eigene Antiken konstruiert werden. In den untersuchten vorkolonialen, kolonialen und postkolonialen Zusammenhängen wird die Antike durch die zeitgenössische Geschichtspolitik stark mitbestimmt. Der Vergleich lässt die Verflechtung der Vorstellungen über die Vergangenheit zwischen „klassischer“ europäischer, indischer und mesoamerikanischer Antike von der frühen Neuzeit bis in die Gegenwart erkennen. Das Buch bietet Denkanstöße für Personen, die sich mit historisch interessierter Kulturanthropologie, kritischer Altertumswissenschaft und Globalgeschichte beschäftigen.

Achievements of the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences in South-Southeast Asia.

Since 2008, the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences has contributed to ensuring the substitution of sharp curettage by manual vacuum aspiration (MVA) and medical abortion in selected hospitals in participating countries of South-Southeast Asia. This initiative facilitated the registration of misoprostol in Pakistan and Bangladesh, and the approval of mifepristone for "menstrual regulation" in Bangladesh. The Pakistan Nursing Council agreed to include MVA and medical abortion in the midwifery curriculum. The Bangladesh Government has approved the training of nurses and paramedics in the use of MVA to treat incomplete abortion in selected cases. The Sri Lanka College of Obstetricians and Gynaecologists, in collaboration with partners, has presented a draft petition to the relevant authorities appealing for them to liberalize the abortion law in cases of rape and incest or when lethal congenital abnormalities are present. Significantly, the initiative has introduced or strengthened the provision of postabortion contraception.

Late Pliocene carbonate mineralogy of ODP Hole 133-818B

Shedding of shallow carbonate material toward the deep slopes and basin floors is clearly tied to the position of the carbonate bank tops relative to the photic zone. The onset of bank shedding in periplatform sediments can record either the flooding of the bank tops within the photic zone during a rise in sea level following a period of exposure, referred to in the literature as the "highstand shedding" scenario, or the reentry of the bank tops into the photic zone during a lowering of sea level following a period of drowning, referred to as the "lowstand shedding" scenario. Results from Leg 133 post-cruise research on the Pliocene sequences, drilled in six sites within different slope settings of the Queensland Plateau, seem to point out that the latter "lowstand shedding" scenario can be applied to this particular carbonate system. At the Queensland Plateau sites, the early Pliocene (5.2-3.5 Ma) and the earliest part of the late Pliocene (3.5-2.9 Ma) age sequences were characterized, especially in the ôdeepö Sites 811 and 817, by pelagic sediments (foraminifers and coccoliths) and by typically pelagic sedimentation rates not exceeding 20 mm/k.y. The earliest part of the late Pliocene age section was characterized by well-developed hardgrounds in the "shallow" Sites 812 and 814 and by normal pelagic sediments mixed with reworked phosphatized planktonic foraminifers in Site 813. Finally, the early part of the late Pliocene (2.9-2.4 Ma) section was characterized by high sedimentation rates, related to the shedding and admixture into the pelagic sediments of bank-derived materials. These bank-derived materials consist of either diagenetically unaltered fine aragonite with traces of dolomite in Site 818 or micritic calcite resulting from seafloor and/or shallow burial alteration in the deepest Sites 817 and 811. The highest sedimentation rates (163 mm/k.y.) were recorded in Site 818, drilled nearest the modern carbonate bank of Tregrosse Reef. The sedimentation rates decrease with increasing distance from Tregrosse Reef - 120 mm/k.y. in Site 817 and 47.5 mm/k.y. in Site 811. The initial appearance of fine aragonite in Site 818, corresponding to the transition from pelagic to periplatform sedimentation rates, has been dated at 2.9 Ma. This Pliocene sediment pattern on the Queensland Plateau is different from the pattern observed in sediments from two earlier ODP legs (i.e., Leg 101 in the Bahamas and in Leg 115 in the Maldives), where aragonite-rich sediments, characterized by high periplatform sedimentation rates, were observed in the lower Pliocene section (5.2-3.5 Ma), whereas the upper Pliocene (3.5-1.6 Ma) sediments are more pelagic in nature and are characterized by low sedimentation rates or major hiatuses. These Pliocene periplatform sequences in the Bahamas and in the Maldives and late Quaternary age periplatform sequences worldwide have pointed out that "highstand shedding" was the typical response of carbonate platforms to fluctuations in sea level, just opposite to a "lowstand shedding" response to sea-level fluctuations, typical of siliciclastic shelves. Assuming that the envelope of Haq et al.'s (1987) sea-level curve, showing a well-defined lowering of sea level between 3.5 and 2.9 Ma, can also be applied to the southwest Pacific Ocean, based on a high-resolution Pliocene d18O record from the Ontong Java Plateau recently published by Jansen et al. (1993, doi:10.2973/odp.proc.sr.130.028.1993), the Pliocene periplatform sequences on the Queensland Plateau would have recorded the reentry of the bank tops into the photic zone during a general lowering of sea level, following an interval characterized by high sea level, during which the shallow carbonate system on the Queensland Plateau was drowned. The early Pliocene age (5.2-3.5 Ma) sediments deposited on the Queensland Plateau, an established interval of eustatic sea-level highstand, are typically pelagic in character. In addition, relatively cold surface temperatures (estimated to have ranged from 18° to 20°C by Isern et al. [this volume]) might have also stressed the reefs during early Pliocene time and contributed to the drowning of the Queensland Plateau carbonate system during the late Miocene and early Pliocene. Differential and relatively high subsidence rates, inferred by variations in paleodepth of water (based upon benthic foraminifer assemblages; Katz and Miller, this volume) may also have influenced the drowning of the carbonate bank tops on the Queensland Plateau during the late Miocene and early Pliocene. The sediments of early late Pliocene age (2.9-2.4 Ma), a well-established interval of lowering of sea level, are clearly periplatform and cyclic in nature. High-frequency (~40 k.y.) aragonite cycles, well-developed between 2.9 and 2.45 Ma, correlate with the planktonic high-resolution Pliocene d18O record from the Ontong Java Plateau, a good sea-level proxy (Jansen et al., in press). Contrary to late Quaternary age aragonite cycles from the Bahamas, the Nicaragua Rise, the Maldives, and the Queensland Plateau, the late Pliocene aragonite cycles in Hole 818B display high levels of aragonite during glacial stages and, therefore, lowstands of sea level. In addition, sediments deposited during the earliest part of the late Pliocene (3.5-2.9 Ma), transition between the early Pliocene highstand and the late Pliocene lowering in sea level, have recorded the first evidence of a fall in sea level, by (1) the occurrence of synchronous submarine hardgrounds in the two shallowest sites (Sites 812 and 814), (2) the deposition of reworked material from the shallower part of the slope into the intermediate Sites 813 and 818, and (3) the deposition of pelagic sediments in the deepest Sites 817 and 817. In summary, contrary to previous findings, the Pliocene periplatform sediments on the Queensland Plateau appear to have recorded a regional shedding of shallow carbonate bank tops during an interval of sea-level lowering, a good illustration of the "carbonate lowstand shedding" scenario, occurring during the reentry of previously drowned carbonate bank tops into the photic zone related to a decrease in sea level.

Results of biological and geological bottom investigations carried out during Cruise 43 of R/V Akademik Kurchatov in the South Atlantic

The book is devoted to investigations of benthic fauna and geology of the Southern Atlantic Ocean. These works have been carried out in terms of exploring biological structure of the ocean and are of great importance for development of this fundamental problem. They are based on material collected during Cruise 43 of R/V Akademik Kurchatov in 1985-1986 and Cruise 43 of R/V Dmitry Mendeleev in 1989. Problems of quantitative distribution, group composition and trophic structure of benthos in the Southern Scotia Sea, along the east-west Transatlantic section along 31°30'S, and offshore Namibia in the area of the Benguela upwelling are under consideration in the book. Authors present new data on fauna of several groups of deep-sea bottom animals and their zoogeography. Much attention is paid to analysis of morphological structure of the Scotia Sea floor considered in terms of plate tectonics. Bottom sediments along the Transatlantic section and facial variation of sediments in the area of South Shetland Islands and of the continental margin of Namibia are under consideration.

Time-series of seagrass and land cover maps from 1972 to 2010, in South East Queensland, Australia, with links to GeoTIFFs

Long term global archives of high-moderate spatial resolution, multi-spectral satellite imagery are now readily accessible, but are not being fully utilised by management agencies due to the lack of appropriate methods to consistently produce accurate and timely management ready information. This work developed an object-based remote sensing approach to map land cover and seagrass distribution in an Australian coastal environment for a 38 year Landsat image time-series archive (1972-2010). Landsat Multi-Spectral Scanner (MSS), Thematic Mapper (TM) and Enhanced Thematic Mapper (ETM+) imagery were used without in situ field data input (but still using field knowledge) to produce land and seagrass cover maps every year data were available, resulting in over 60 map products over the 38 year archive. Land cover was mapped annually using vegetation, bare ground, urban and agricultural classes. Seagrass distribution was also mapped annually, and in some years monthly, via horizontal projected foliage cover classes, sand and deep water. Land cover products were validated using aerial photography and seagrass maps were validated with field survey data, producing several measures of accuracy. An average overall accuracy of 65% and 80% was reported for seagrass and land cover products respectively, which is consistent with other studies in the area. This study is the first to show moderate spatial resolution, long term annual changes in land cover and seagrass in an Australian environment, created without the use of in situ data; and only one of a few similar studies globally. The land cover products identify several long term trends; such as significant increases in South East Queensland's urban density and extent, vegetation clearing in rural and rural-residential areas, and inter-annual variation in dry vegetation types in western South East Queensland. The seagrass cover products show that there has been a minimal overall change in seagrass extent, but that seagrass cover level distribution is extremely dynamic; evidenced by large scale migrations of higher seagrass cover levels and several sudden and significant changes in cover level. These mapping products will allow management agencies to build a baseline assessment of their resources, understand past changes and help inform implementation and planning of management policy to address potential future changes.

Megnetic susceptibility of a subtropical South Atlantic transect

The Mid-Pleistocene transition (MPT) of the global climate system, initiated by a shift towards much larger northern hemisphere ice shields at around 920 ka and ending with predominance of 100 kyr ice age cyclicity since about 640 ka, is one of the fundamental enigmas in Quaternary climate evolution. Climate proxy records not exclusively linked to global ice volume are necessary to advance understanding of the MPT. Here we present a high-resolution Pleistocene magnetic susceptibility time series of 12 sediment cores from the subtropical South Atlantic essentially reflecting dissolution driven variations in carbonate accumulation controlled by changes in deep water circulation. In addition to characteristics known from delta18O records, the data sets reveal three remarkable features intimately related to the MPT: (1) an all-Pleistocene minimum of carbonate accumulation in the South Atlantic at 920 ka, (2) a MPT interim state of reduced carbonate deposition, indicating that the MPT period may have been a discrete state of the Pleistocene deep water circulation and climate system and (3) a terminal MPT event at around 540-530 ka documented in several peculiarities such as thick laminated layers of the giant diatom Ethmodiscus rex.

Middle Eocene-Early Pliocene Subantarctic planktic foraminiferal biostratigraphy of ODP Site 1090 on the Agulhas Ridge, South Atlantic

The analysis of planktic foraminiferal assemblages from Site 1090 (ODP Leg 177), located in the central part of the Subantarctic Zone south of South Africa, provided a geochronology of a 330-m-thick sequence spanning the Middle Eocene to Early Pliocene. A sequence of discrete bioevents enables the calibration of the Antarctic Paleogene (AP) Zonation with lower latitude biozonal schemes for the Middle-Late Eocene interval. In spite of the poor recovery of planktic foraminiferal assemblages, a correlation with the lower latitude standard planktic foraminiferal zonations has been attempted for the whole surveyed interval. Identified bioevents have been tentatively calibrated to the geomagnetic polarity time scale following the biochronology of Berggren et al. (1995). Besides planktic foraminiferal bioevents, the disappearance of the benthic foraminifera Nuttallides truempyi has been used to approximate the Middle/Late Eocene boundary. A hiatus of at least 11.7 Myr occurs between V78 and V71 m composite depth extending from the Early Miocene to the latest Miocene-Early Pliocene. Middle Eocene assemblages exhibit a temperate affinity, while the loss of several planktic foraminiferal species by late Middle to early Late Eocene time reflects cooling. During the Late Eocene-Oligocene intense dissolution caused impoverishment of planktic foraminiferal assemblages possibly following the emplacement of cold, corrosive bottom waters. Two warming peaks are, however, observed: the late Middle Eocene is marked by the invasion of the warmer water Acarinina spinuloinflata and Hantkenina alabamensis at 40.5 Ma, while the middle Late Eocene experienced the immigration of some globigerinathekids including Globigerinatheka luterbacheri and Globigerinatheka cf. semiinvoluta at 34.3 Ma. A more continuous record is observed for the Early Miocene and the Late Miocene-Early Pliocene where planktic foraminiferal assemblages show a distinct affinity with southern mid- to high-latitude faunas.

The Changing Nature of Employment and the Reform of Labor and Social Security Legislation in Post-Apartheid South Africa

This paper tries to understand the current status of South African labor market, which is changing in contradictory directions, i.e. a strengthening of the rights and protection of workers at the same time as the flexibilization of employment, in the context of the characteristics of labor and social security legislation in South Africa, as well as the nature of labor and social security reforms after democratization. We put emphasis on the corporatist nature of labor policy-making as the factor influencing the course of reforms; it is argued that the apparently contradictive changes can be explained consistently by the corporatist labor policy-making process which has been practiced notwithstanding the problem of representativeness.