Epidemiological patterns of hepatitis B virus (HBV) in highly endemic areas

This paper uses meta-analysis of published data and a deterministic mathematical model of hepatitis B virus (HBV) transmission to describe the patterns of HBV infection in high endemicity areas. We describe the association between the prevalence of carriers and a simple measure of the rate of infection, the age at which half the population have been infected (A50), and assess the contribution of horizontal and perinatal transmission to this association. We found that the two main hyper-endemic areas of sub-Saharan Africa and east Asia have similar prevalences of carriers and values of A50, and that there is a negative nonlinear relationship between A50 and the prevalence of carriers in high endemicity areas (Spearman's Rank, P = 0·0086). We quantified the risk of perinatal transmission and the age-dependent rate of infection to allow a comparison between the main hyper-endemic areas. East Asia was found to have higher prevalences of HBeAg positive mothers and a greater risk of perinatal transmission from HBeAg positive mothers than sub-Saharan Africa, though the differences were not statistically significant. However, the two areas have similar magnitudes and age-dependent rates of horizontal transmission. Results of a simple compartmental model suggest that similar rates of horizontal transmission are sufficient to generate the similar patterns between A50 and the prevalences of carriers. Interrupting horizontal transmission by mass immunization is expected to have a significant, nonlinear impact on the rate of acquisition of new carriers

Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings

Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely

Revival of the magnetar PSR J1622-4950: observations with MeerKAT, Parkes, XMM-Newton, Swift, Chandra, and NuSTAR

New radio (MeerKAT and Parkes) and X-ray (XMM-Newton, Swift, Chandra, and NuSTAR) observations of PSR J1622-4950 indicate that the magnetar, in a quiescent state since at least early 2015, reactivated between 2017 March 19 and April 5. The radio flux density, while variable, is approximately 100x larger than during its dormant state. The X-ray flux one month after reactivation was at least 800x larger than during quiescence, and has been decaying exponentially on a 111+/-19 day timescale. This high-flux state, together with a radio-derived rotational ephemeris, enabled for the first time the detection of X-ray pulsations for this magnetar. At 5%, the 0.3-6 keV pulsed fraction is comparable to the smallest observed for magnetars. The overall pulsar geometry inferred from polarized radio emission appears to be broadly consistent with that determined 6-8 years earlier. However, rotating vector model fits suggest that we are now seeing radio emission from a different location in the magnetosphere than previously. This indicates a novel way in which radio emission from magnetars can differ from that of ordinary pulsars. The torque on the neutron star is varying rapidly and unsteadily, as is common for magnetars following outburst, having changed by a factor of 7 within six months of reactivation.Comment: Published in ApJ (2018 April 5); 13 pages, 4 figure

Medical students’ child health experience in primary schools:‘the best day of her life’

Objectives: This study was designed to explore medical students’ and primary school teachers’ experiences of a new community teaching project. Academic staff and students from the School of Medicine Dundee, National Health Service partners, Local Education Department and Primary School Teachers engaged in a collaborative project which has embedded community engagement in the curriculum whilst encouraging inter-professional education through multi agency working.Methods: Influenced by evaluative inquiry this qualitative study used an online questionnaire, designed to give participants the freedom to respond, and give their own opinions, via free text responses.Results: The results show the value of a real primary school-based situation, and the merit of experiential learning gained throughout the programme, in which students interacted with children about health promotion in a meaningful way.Conclusion: The inter-professional and collaborative nature of the project enhanced the value of the experience for all participants in relation to the benefits of teamwork, dispelling the doctor authority and recognition of the roles of others. The experience was an interactive, enjoyable and expressiveway to facilitate learning, and has helped prepare the healthcare students for future practice

CD4+ T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa

Background: Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally. Methods: We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitor-based regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/µl in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years. Results: After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/µl was 529/µl [95% confidence interval (CI): 517-541] in North America, 494/µl (95% CI: 429-559) in West Africa, 515/µl (95% CI: 508-522) in Southern Africa, 503/µl (95% CI: 478-528) in Asia and 437/µl (95% CI: 425-449) in East Africa. Conclusions: CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional leve

Quality assessment and primary uses of harvested rainwater in Kleinmond, South Africa

water security, reaching the Millennium Development Goals (MDGs) and sustaining water resources. The microbial and chemical quality of RWH samples collected from tanks in a sustainable housing development in Kleinmond, South Africa, were monitored. Results indicated that the tank water quality was within all the chemical standards (cations and anions) analysed for potable water. However, the counts of the indicator organisms, for example, total coliforms and Escherichia coli, exceeded the guidelines stipulated by the Department of Water Affairs and Forestry (1996). The microbial analysis results thus indicate that the tank water was not fit for potable use without treatment. A social research project was then conducted to describe, amongst others, the condition of the tank and the users’ knowledge of the RWH system. In addition, demographic data, viz., gender, household size and employment status, etc., were gathered in order to provide a socio-economic background description of the study population. Data were gathered by means of face-to-face interviews with 68 respondents. Generally, RWH was used for washing clothes and for cleaning inside and outside the houses. This study noted that without acceptance and necessary training to maintain and use the tank optimally, it is possible that social development projects, such as the one in Kleinmond, will not be sustainable.Keywords: domestic rainwater harvesting; microbial and chemical quality; social perception; acceptanc

Characterization and genomic analyses of two newly isolated Morganella phages define distant members among Tevenvirinae and Autographivirinae subfamilies

Morganella morganii is a common but frequent neglected environmental opportunistic pathogen which can cause deadly nosocomial infections. The increased number of multidrug-resistant M. morganii isolates motivates the search for alternative and effective antibacterials. We have isolated two novel obligatorily lytic M. morganii bacteriophages (vB_MmoM_MP1, vB_MmoP_MP2) and characterized them with respect to specificity, morphology, genome organization and phylogenetic relationships. MP1s dsDNA genome consists of 163,095bp and encodes 271 proteins, exhibiting low DNA (10kb chromosomal inversion that encompass the baseplate assembly and head outer capsid synthesis genes when compared to other T-even bacteriophages. MP2 has a dsDNA molecule with 39,394bp and encodes 55 proteins, presenting significant genomic (70%) and proteomic identity (86%) but only to Morganella bacteriophage MmP1. MP1 and MP2 are then novel members of Tevenvirinae and Autographivirinae, respectively, but differ significantly from other tailed bacteriophages of these subfamilies to warrant proposing new genera. Both bacteriophages together could propagate in 23 of 27M. morganii clinical isolates of different origin and antibiotic resistance profiles, making them suitable for further studies on a development of bacteriophage cocktail for potential therapeutic applications.This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2013 unit, COMPETE 2020 (POCI-01-0145-FEDER-006684) and the Project PTDC/BBB-BSS/6471/2014 (POCI-01-0145-FEDER-016678). RL contributed to the genome sequencing analysis, supported by the KU Leuven GOA Grant ‘Phage Biosystems’. JP acknowledges the project R-3986 of the Herculesstichting.info:eu-repo/semantics/publishedVersio

Books

Progress in Medical Virology. Vol. 39. Ed. by J. L. Melnick. Pp. x + 270. Illustrated. £115,70. Basel: S Karger. 1992.Assisted reproduction Micromanipulation of Human Gametes and Embryos. By J. Cohen, H. E. Malter, Beth E. Talansky and J. Grifo. pp. ix + 325. Illustrated. $111,50. New York: Raven Press. 1992.Congenital rubella syndrome EpideIDio1ogy and Infection. Vo!. 107 No. 1. Ed. by J. R. Partison, D. Baxby, J. G. Cruickshank, C. R. Madeley and W. C. Noble. Pp. viii + 239. Illustrated. £25. Cambridge: Cambridge University Press. 1991.Rural and urban hospitals The Hospital in Rural and Urban Districts: Report of a WHO Study Group on the Function of Hospitals at the First Referral Level. pp. vii + 74. SFr.120. Geneva: World Health Organisation. 1992.Perinatology Perinato1ogy: Nestle Nutrition Workshop Series. Vol. 26. Ed. by Erich Saling. pp. xiii + 194. illustrated.$69. New York: Raven Press. 1992.Anaesthetists Five Decades: The South African Society· of Anaesthetists 1943 - 1993. By Nagin Parbhoo. 330 pages and 70 phoros and illustrations. Published by the South African Society of Anaesthetists. Printed by National Book Printers.

Ultrastructural morphology of Cowdria ruminantium in midgut epithelial cells of adult Amblyomma hebraeum female ticks

Amblyomma hebraeum male and female ticks, experimentally infected as larvae with the Ball 3 stock of Cowdria ruminantium, were fed on a heartwater susceptible sheep. The initial attachment of the males was required as a pre-requisite for female attachment.Reticulate bodies were the predominant morphologic form of Cowdria observed in gut epithelial cells after 1-3 days of feeding. Single intermediate bodies and no elementary bodies were observed. Organisms were found within a membrane-bound vacuole and each organism had a double-unit membrane. Infrequently colonies contained homogeneous electron-dense inclusions. Groups of Cowdria organisms within a haemocyte suggested a possible dissemination of organisms from the gut to various other tissues by haemocytes.Peer reviewedVeterinary Patholog

Exploring medical curriculum leadership and management training : perspectives of doctors and medical educators in Botswana

BACKGROUND: The University of Botswana Faculty of Medicine (UB FOM) is the only medical school in Botswana, and was opened to address shortages that other workforce strategies were not achieving at a sufficient rate. The UB FOM programme involves early patient contact at all levels of healthcare. Newly-graduated doctors are expected to perform managerial responsibilities, a role which few medical curricula include formal training for. OBJECTIVES: To explore the perceptions of graduates and medical educators (MEs) on the leadership and management training in the medical curriculum in Botswana. METHODS: A non-theory driven qualitative study using thematic analysis was conducted. Twelve MEs and graduates from UB FOM were interviewed. Semi-structured interviews were conducted until data saturation was reached. Data were transcribed and analysed. RESULTS: Two themes were developed: Starting small to be tall and Planting the seeds. Theme 1 describes the explicit messages of being future managers and leaders unaccompanied by formal training. Theme 2 acknowledges the insufficient training and describes the call for scaffolded longitudinal leadership and management teaching, and enhanced interprofessional education. CONCLUSION: Elements of leadership and management training are already included within the curriculum. The health system expectation that these graduates will immediately assume leadership and management responsibilities necessitates the strengthening of these aspects. The inclusion of critical content and further expansion of interprofessional education can be considered. The UB FOM is in a position to actualise its identified leadership and management competencies to serve the needs of its graduates and those in their care.The Department of Research and Innovation, University of Pretoria Research Development Programme and the University Capacity Development Programme for the University of Pretoria.http://www.ajhpe.org.za/School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-beingSDG-04:Quality Educatio