Micronutrient supplementation in adults with HIV infection.

Background Micronutrient deficiencies are common among adults living with HIV disease, particularly in low-income settings where the diet may be low in essential vitamins and minerals. Some micronutrients play critical roles in maintenance of the immune system, and routine supplementation could therefore be beneficial. This is an update of a Cochrane Review previously published in 2010. Objectives To assess whether micronutrient supplements are effective and safe in reducing mortality and HIV-related morbidity of HIV-positive adults (excluding pregnant women). Search methods We performed literature searches from January 2010 to 18 November 2016 for new randomized controlled trials (RCTs) of micronutrient supplements since the previous review included all trials identified from searches prior to 2010. We searched the CENTRAL (the Cochrane Library), Embase, and PubMed databases. Also we checked the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and the ClinicalTrials.gov trials registers. We also checked the reference lists of all new included trials. Selection criteria We included RCTs that compared supplements that contained either single, dual, or multiple micronutrients with placebo, no treatment, or other supplements. We excluded studies that were primarily designed to investigate the role of micronutrients for the treatment of HIV-positive participants with metabolic morbidity related to highly active antiretroviral therapy (HAART). Primary outcomes included all-cause mortality, morbidity, and disease progression. Data collection and analysis Two review authors independently selected trials for inclusion, and appraised trial quality for risk of bias. Where possible, we presented results as risk ratios (RR) for dichotomous variables, as hazard ratios (HRs) for time-to-event data, and as mean differences (MD) for continuous variables, each with 95% confidence intervals (CIs). Since we were often unable to pool the outcome data, we tabulated it for each comparison. We assessed the certainty of the evidence using the GRADE approach. Main results We included 33 trials with 10,325 participants, of which 17 trials were new trials. Ten trials compared a daily multiple micronutrient supplement to placebo in doses up to 20 times the dietary reference intake, and one trial compared a daily standard dose with a high daily dose of multivitamins. Nineteen trials compared supplementation with single or dual micronutrients (such as vitamins A and D, zinc, and selenium) to placebo, and three trials compared different dosages or combinations of micronutrients. Multiple micronutrients We conducted analyses across antiretroviral therapy (ART)-naive adults (3 trials, 1448 participants), adults on antiretroviral therapy (ART) (1 trial, 400 participants), and ART-naive adults with concurrent active tuberculosis (3 trials, 1429 participants). Routine multiple micronutrient supplementation may have little or no effect on mortality in adults living with HIV (RR 0.91, 95% CI 0.72 to 1.15; 7 trials, 2897 participants, low certainty evidence). Routine supplementation for up to two years may have little or no effect on the average of mean CD4+ cell count (MD 26.40 cells/mm³, 95% CI −22.91 to 75.70; 6 trials, 1581 participants, low certainty evidence), or the average of mean viral load (MD −0.1 log10viral copies, 95% CI −0.26 to 0.06; 4 trials, 840 participants, moderate certainty evidence). One additional trial in ART-naïve adults did report an increase in the time to reach a CD4+ cell count < 250 cells/mm³ after two years of high dose supplementation in Botswana (HR 0.48, 95% CI 0.26 to 0.88; 1 trial, 439 participants). However, the trial authors reported this effect only in the trial arm that received multiple micronutrients plus selenium (not either supplementation alone), which is inconsistent with the findings of other trials that used similar combinations of micronutrients and selenium. In one additional trial that compared high-dose multiple micronutrient supplementation with standard doses in people on ART, peripheral neuropathy was lower with high dose supplements compared to standard dose (incidence rate ratio (IRR) 0.81, 95% CI 0.7 to 0.94; 1 trial, 3418 participants), but the trial was stopped early due to increased adverse events (elevated alanine transaminase (ALT) levels) in the high dose group. Single or dual micronutrients None of the trials of single or dual micronutrient supplements were adequately powered to assess for effects on mortality or morbidity outcomes. No clinically significant changes in CD4 cell count (data not pooled, 14 trials, 2370 participants, very low or low certainty evidence) or viral load (data not pooled, seven studies, 1334 participants, very low or low certainty evidence), were reported. Supplementation probably does increase blood concentrations of vitamin D and zinc (data not pooled, vitamin D: 4 trials, 299 participants, zinc: 4 trials, 484 participants, moderate certainty evidence) and may also increase blood concentrations of vitamin A (data not pooled, 3 trials, 495 participants, low certainty evidence), especially in those who are deficient. Authors' conclusions The analyses of the available trials have not revealed consistent clinically important benefits with routine multiple micronutrient supplementation in people living with HIV. Larger trials might reveal small but important effects. These findings should not be interpreted as a reason to deny micronutrient supplements for people living with HIV where specific deficiencies are found or where the person's diet is insufficient to meet the recommended daily allowance of vitamins and minerals

Classification of calorimetric titration plots for alkyltrimethylammonium and alkylpyridinium cationic surfactants in aqueous solutions

Calorimetric titration plots for deaggregation of micelles formed by alkylpyridinium and alkyltrimethylammonium surfactants are classified into three types, A, B and C, depending on the shape of the plot of the enthalpy of dilution as a function of surfactant concentration. For Type A plots the recorded heat of injection q changes sharply between two parts of the titration curve over which the recorded heats are effectively independent of the composition of the solution in the sample cell. For Type B plots, the change is less sharp and both parts of the plot show dependences of heat q on solution composition, a pattern accounted for in terms of solute-solute interactions. Type C plots are complicated, in that no sharp change in q is recorded, the complexity of the plots being accounted for in terms of micelle-monomer equilibria over a range of surfactant concentrations and related enthalpies of deaggregation

Binarism and indeterminacy in the novels of Thomas Pynchor

Bibliography: pages 397-401.I attempt in this thesis, to graft together a close critical, and predominantly thematic, reading of Thomas Pynchon's novels with selected issues treated in the work of Jacques Derrida on philosophy and textuality, illustrating how this work demands the revision and interrogation of several major critical issues, concepts, dualisms and presuppositions. The thesis consists of an Introduction which sets forth a brief rationale for the graft described above, followed by a short and unavoidably inadequate synopsis of Derrida's work with a brief review and explication of those of his 'concepts' which play an important role in my reading of Pynchon's texts. The Introduction is succeeded by three lengthy chapters in which I discuss, more or less separately, each of Pynchon's three novels to date. These are V. (1963), The Crying of Lot 49, (1966) and Gravity's Rainbow (1973), and I discuss them in the order of their appearance, devoting a chapter to each. I attempt to treat different but related issues, preoccupations, themes and tropes in each of the novels to avoid repeating myself, engaging the apparatuses derived from Derrida's writing where deemed strategic and instructive. I suggest moreover, that several of the issues examined apropos the novel under consideration in any one chapter apply mutandis rnutandi to the other novels. Each chapter therefore to some extent conducts a reading of the novels which it does not treat directly. Finally, supervising these separate chapters is a sustained focus on the epistemology of binarism and digitalism, and the conceptual dualisms which structure and inform major portions of the thematic and rhetorical dimensions The thesis concludes with a Bibliography and a summary Epilogue which seeks to assess briefly the 'achievement' of Pynchon's writing

Career plans of final-year medical students in South Africa

There is strong international evidence that students of rural origin, and those who intend to practise rural medicine, are more likely to practise in rural settings after graduation.2 The purpose of this study was to survey final-year medical students about their career plans and the influences on those plans, to ascertain implications for the future training of doctors in South Africa

Effects on mortality of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: a randomised controlled trial.

Malnourished HIV-infected African adults are at high risk of early mortality after starting antiretroviral therapy (ART). We hypothesized that short-course, high-dose vitamin and mineral supplementation in lipid nutritional supplements would decrease mortality

Career and practice intentions of health science students at three South African health science faculties

Background. The distribution and accessibility of healthcare professionals as well as the quality of healthcare services are significantly affected by the career choices of medical and other health science graduates.Objective. While much has been reported on the career intentions of medical students, little is known about those of their counterparts in the health sciences. This study describes the career plans of non-medical health science students at three South African health science faculties, and identifies some key motivating factors.Methods. A self-administered survey of first- and final-year health science students was conducted at the health science faculties of the universities of Cape Town, KwaZulu-Natal and Limpopo. All data were entered into EpiData software and exported for analysis using IBM SPSS Statistics 19.0.Results and discussion. The overall response rate was 47% (N=816). Over half of all respondents (57%, n=467) intended to work after completing their undergraduate studies, 38% (n=177) of these in a rural area. The most popular choices were private hospitals (58%, n=273), tertiary hospitals (53%, n=249) and private practices (51%, n=249). Thirty-two per cent (n=258) of respondents intended to further their studies. Just over half of all respondents intended to work in another country (51%, n=418), primarily motivated by career development, financial reasons and job opportunities.Conclusion. The findings demonstrate that health science students, similar to medical students, are influenced by a multitude of factors in making career choices. This emphasises the relevance to all health science disciplines of national strategies to address the maldistribution of healthcare professionals

Barriers to cycling in informal settlements

A study was undertaken in October 2015 to determine the barriers to cycling mobility in Masiphumelele, a low-income community in Cape Town. An initial focus group discussion informed the design of a household survey of 100 residents on commuter cycling. This included a stated choice survey using Best-Worst Scaling (BWS) of the relative importance of 20 potential barriers to cycling mobility. Minibus taxis were the primary mode of household transport (93%); walking (44%), train (23%), bicycle (16%) and bus (11%) were important secondary modes. 32% of households owned at least one bicycle that is used for transport. 22% of participants reported that they cycle fairly often or regularly, primarily to save money (44%), keep fit and healthy (32%), and to save time (15%). 68% supported promotion of cycling mobility in Masiphumelele. Leading barriers to cycling identified by the BWS survey were concerns about road safety; inability to transport loads on a bicycle; inability to commute with a bicycle by train during peak commuting hours; and concerns about arriving late for work. Key recommendations for increasing cycling mobility in Masiphumelele are to actively promote the benefits of cycling, educate about road safety, teach cycling skills, make bicycles and spares more affordable, enhance the safety of the cycling environment, and to build local capacity.No paper, Abstract onlyPaper presented at the 35th Annual Southern African Transport Conference 4-7 July 2016 "Transport ? a catalyst for socio-economic growth and development opportunities to improve quality of life", CSIR International Convention Centre, Pretoria, South Africa.The Minister of Transport, South AfricaTransportation Research Board of the US

El Pigmalión colonial: Dinesen trastocado en Out of Africa

This paper explores the atavistic and feudal historical fantasies that structure Isak Dinesen’s 1937 memoir, Out of Africa. It analyses the imagery and symbolic logic of the memoir in conjunction with Dinesen’s letters from Africa in order to examine how Dinesen derives an idiom to speak of Africa that synthesizes the social structures of European feudalism, the discourse of the noble savage and the aesthetics of the sublime. The paper seeks to unpack the conundrum that fashions a modern, emancipated female subjectivity from the anachronistic paradigm of feudalism and within the framework of imperial domination and colonial occupation. The paper explores how Dinesen’s feudal idiom extends the genre of European pastoral to the colonial milieu and places it in the service of a larger search for a discourse of legitimacy. I argue that this is an abiding preoccupation of colonial literature. I analyze in detail the specular logic through which the narrator confronts Africa as a space that alternately panders to or challenges the psycho-political narcissism of the settler. Dinesen’s memoir reveals the myriad operations of the narcissistic structure through which the narrator strives to fill the copula of the question, “What is Africa to you or you to Africa?”Este trabajo explora las fantasías históricas de carácter atávico y feudal que vertebran las memorias de Isak Dinesen en Out of Africa (1937). Explora el imaginario y la lógica del simbolismo en las memorias junto con las cartas escritas por Dinesen desde África para analizar cómo Dinesen construyó todo un lenguaje para hablar de África que sintetiza las estructuras sociales del feudalismo europeo, el discurso del buen salvaje y la estética de lo sublime. El trabajo intenta explicar la manera rebuscada por medio de la cual se construye la subjetividad de la mujer moderna y emancipada desde el paradigma anacrónico del feudalismo y dentro del marco de la dominación imperial y la ocupación colonial. El trabajo explora cómo el lenguaje feudal en Dinesen extiende el género de lo pastoral europeo hacia el ámbito colonial para ponerlo en función de la búsqueda de un discurso de legitimidad. Sostengo que esta es una preocupación constante de la literatura colonial. Analizo en detalle la lógica reflexiva mediante la cual la narradora se enfrenta a África como un espacio que a una vez mima y rechaza el narcisismo psicopolítico del colono. Las memorias de Dinesen ponen en evidencia un sinnúmero de maquinaciones de carácter narcisista mediante las cuales la narradora intenta manejar el tándem enredado de la pregunta “¿Qué significa África para ti y tu qué eres para África?