Estimating loss to follow-up in HIV-infected patients on antiretroviral therapy: the effect of the competing risk of death in Zambia and Switzerland

Background Loss to follow-up (LTFU) is common in antiretroviral therapy (ART) programmes. Mortality is a competing risk (CR) for LTFU; however, it is often overlooked in cohort analyses. We examined how the CR of death affected LTFU estimates in Zambia and Switzerland. Methods and Findings HIV-infected patients aged ≥18 years who started ART 2004–2008 in observational cohorts in Zambia and Switzerland were included. We compared standard Kaplan-Meier curves with CR cumulative incidence. We calculated hazard ratios for LTFU across CD4 cell count strata using cause-specific Cox models, or Fine and Gray subdistribution models, adjusting for age, gender, body mass index and clinical stage. 89,339 patients from Zambia and 1,860 patients from Switzerland were included. 12,237 patients (13.7%) in Zambia and 129 patients (6.9%) in Switzerland were LTFU and 8,498 (9.5%) and 29 patients (1.6%), respectively, died. In Zambia, the probability of LTFU was overestimated in Kaplan-Meier curves: estimates at 3.5 years were 29.3% for patients starting ART with CD4 cells <100 cells/µl and 15.4% among patients starting with ≥350 cells/µL. The estimates from CR cumulative incidence were 22.9% and 13.6%, respectively. Little difference was found between naïve and CR analyses in Switzerland since only few patients died. The results from Cox and Fine and Gray models were similar: in Zambia the risk of loss to follow-up and death increased with decreasing CD4 counts at the start of ART, whereas in Switzerland there was a trend in the opposite direction, with patients with higher CD4 cell counts more likely to be lost to follow-up. Conclusions In ART programmes in low-income settings the competing risk of death can substantially bias standard analyses of LTFU. The CD4 cell count and other prognostic factors may be differentially associated with LTFU in low-income and high-income settings.

A clinical prediction model to identify patients at high risk of death in the emergency department.

PURPOSE Rapid assessment and intervention is important for the prognosis of acutely ill patients admitted to the emergency department (ED). The aim of this study was to prospectively develop and validate a model predicting the risk of in-hospital death based on all available information available at the time of ED admission and to compare its discriminative performance with a non-systematic risk estimate by the triaging first health-care provider. METHODS Prospective cohort analysis based on a multivariable logistic regression for the probability of death. RESULTS A total of 8,607 consecutive admissions of 7,680 patients admitted to the ED of a tertiary care hospital were analysed. Most frequent APACHE II diagnostic categories at the time of admission were neurological (2,052, 24 %), trauma (1,522, 18 %), infection categories [1,328, 15 %; including sepsis (357, 4.1 %), severe sepsis (249, 2.9 %), septic shock (27, 0.3 %)], cardiovascular (1,022, 12 %), gastrointestinal (848, 10 %) and respiratory (449, 5 %). The predictors of the final model were age, prolonged capillary refill time, blood pressure, mechanical ventilation, oxygen saturation index, Glasgow coma score and APACHE II diagnostic category. The model showed good discriminative ability, with an area under the receiver operating characteristic curve of 0.92 and good internal validity. The model performed significantly better than non-systematic triaging of the patient. CONCLUSIONS The use of the prediction model can facilitate the identification of ED patients with higher mortality risk. The model performs better than a non-systematic assessment and may facilitate more rapid identification and commencement of treatment of patients at risk of an unfavourable outcome.

The effective and the evocative : reflecting on practice-led research approaches in art and design

Early in the practice-led research debate, Steven Scrivener (2000, 2002) identified some general differences in the approach of artists and designers undertaking postgraduate research. His distinctions centered on the role of the artefact in problem-based research (associated with design) and creative-production research (associated with artistic practice). Nonetheless, in broader discussions on practice-led research, 'art and design' often continues to be conflated within a single term. In particular, marked differences between art and design methodologies, theoretical framing, research goals and research claims have been underestimated. This paper revisits Scrivener's work and establishes further distinctions between art and design research. It is informed by our own experiences of postgraduate supervision and research methods training, and an empirical study of over sixty postgraduate, practice-led projects completed at the Creative Industries Faculty of QUT between 2002 and 2008. Our reflections have led us to propose that artists and designers work with differing research goals (the evocative and the effective, respectively), which are played out in the questions asked, the creative process, the role of the artefact and the way new knowledge is evidenced. Of course, research projects will have their own idiosyncrasies but, we argue, marking out the poles at each end of the spectrum of art and design provides useful insights for postgraduate candidates, supervisors and methodologists alike.

Open in art, nature and emergence

The interactive art system +-now is modelled on the openness of the natural world. Emergent shapes constitute a novel method for facilitating this openness. With the art system as an example, the relationship between openness and emergence is discussed. Lastly, artist reflections from the creation of the work are presented. These describe the nature of open systems and how they may be created.

Alter/Asians : Asian-Australian Identities in Art, Media and Popular Culture

Exploration of how Australia and Asia are intertwined in everyday culture, and in the imagined worlds of Australians of all backgrounds. Investigates Asian cultural production of art, literature, media and performance that embody Asian social and cultural experiences. Includes endnotes, bibliography and index. Ang and Chalmers work in the School of Cultural Studies at University of Western Sydney. Law and Thomas are Australian Research Council Postdoctoral Fellows at Australian National University and the Research Centre in Inter-communal Studies respectively.

Polymer nanocarrier system for endosome escape and timed release of siRNA with complete gene silencing and cell death in cancer cells

An influenza virus-inspired polymer mimic nanocarrier was used to deliver siRNA for specific and near complete gene knockdown of an osteoscarcom cell line (U-2SO). The polymer was synthesized by single-electron transfer living radical polymerization (SET-LRP) at room temperature to avoid complexities of transfer to monomer or polymer. It was the only LRP method that allowed good block copolymer formation with a narrow molecular weight distribution. At nitrogen to phosphorus (N/P) ratios of equal to or greater than 20 (greater than a polymer concentration of 13.8 μg/mL) with polo-like kinase 1 (PLK1) siRNA gave specific and near complete (>98%) cell death. The polymer further degrades to a benign polymer that showed no toxicity even at polymer concentrations of 200 μg/mL (or N/P ratio of 300), suggesting that our polymer nanocarrier can be used as a very effective siRNA delivery system and in a multiple dose administration. This work demonstrates that with a well-designed delivery device, siRNA can specifically kill cells without the inclusion of an additional clinically used highly toxic cochemotherapeutic agent. Our work also showed that this excellent delivery is sensitive for the study of off-target knockdown of siRNA.

Surveillance report on cardiovascular causes of death in Shouguang, 1993-1997 [寿光市疾病监测点1993～1997年心血管疾病死亡监测报告]

This analysis showed that cardiovascular diseases were the number cause of death claiming 34% of all deaths. More than half (52%) of all cardiovascular deaths were due to Cerebrovascular diseases and about one-third (32%) were due to ischaemic heart disease. The mortality of cardiovascular diseases showed an increasing trend during this period (1993-1997). Abstract in Chinese 心血管疾病是威胁人们健康的重要疾病之一，在居民死因中占主要位置。为了解心血管疾病死亡状况，我们对寿光市农村疾病监测点１９９３～１９９７年居民死亡资料进行了统计分析，现报告如下。（标化死亡率采用１９９０年全国标准人口构成计算）。１９９３～１９９７年监测...

Valuing those close to us : A comparison of German and Australian quality newspapers’ reporting of death in foreign news

A number of studies into the coverage of death have provided some evidence of journalists giving preference to events from certain regions and to certain types of death. This comprehensive evaluation of how two German and two Australian newspapers cover death specifically in foreign news finds clear evidence that journalists primarily look for events in countries which are culturally proximate to their own. The cultural proximity thesis here includes links such as cultural, political, economic or linguistic connections with a country. Some important national differences in how journalists at the Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung, The Australian and The Sydney Morning Herald report on death were also identified. These could be traced to some important cultural differences between the two countries, underlining the need for more research which locates culture at the core of news analysis.