Magister Public Health - MPH / Despite the effectiveness and scale-up of antiretroviral treatment (ART), HIV-Associated neurocognitive disorders (HAND) still persist. Currently no gold standard tool exists to detect all forms of HAND, including major and minor cognitive impairments. In light of this, a newly developed screening tool was conceptualised, namely the Quick Paediatric Neurocognitive Screening tool (QPNST). The QPNST has been developed to detect HAND in perinatally HIV-infected children aged 5-10 years.

The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of the fistula and PP mesh replacement followed by reinstitution of NPWT and flap closure. In addition to appropriate systemic antibiotics and nutritional optimisation, the adjunctive use of NPWT resulted in successful closure of 86% of infected abdominal wounds with exposed prosthetic mesh. Patient hospital LOS (except those with PG mesh), operative procedures and readmissions were decreased during NPWT compared with treatment prior to NPWT. Future multi-site prospective, controlled studies would provide a strong evidence base from which treatment decisions could be made in the management of these challenging and costly cases.

Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, Wolvos T, Baharestani MM, Gupta S. A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure ® (V.A.C. ®) Therapy: Experience and Case Series. ABSTRACT Over the last decade Vacuum Assisted Closure ® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C. ® Therapy and V.A.C. Instill ® with either GranuFoam ™ or GranuFoam Silver ™ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C. ® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C. ® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C. ® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.

No description available.

yes / Peer-to-Peer (P2P) network is increasingly becoming the most important means of trading content throughout the last years due to the constant evolvement of the cyber world. This popularity made the P2P network susceptible to the spread of malware. The detection of the cause of malware propagation is now critical to the survival of P2P networks. This paper offers a review of the current relevant mathematical propagation models that have been proposed to date to predict the propagation behavior of a malware in a P2P network. We analyzed the models proposed by researchers and experts in the field by evaluating their limitations and a possible alternative for improving the analysis of the expected behavior of a malware spread.

This 2-yr experiment evaluated productivity of wild-type, endophyte-infected tall fescue (E+) and novel endophyte-infected tall fescue (NE) summer stockpiled (SS) pastures and the performance of fall-calving beef cow/calf pairs stocked on each cultivar. Fescue cultivars used were KY-31 and MaxQ for E+ and NE treatments, respectively. Pregnant Simmental x Angus cows (128 total, 64 each yr) were stratified by BW, BCS, and expected calving date and then allotted to 1 of 10 pasture groups within each yr (20 groups total, 10 per treatment). Forage growth was stockpiled from April until the initiation of strip-grazing on August 31 of 2017 and 2018. Cows grazed treatment pastures for 52 d from 23 ± 14 d prepartum to 29 ± 14 d postpartum, and calved on treatment pastures. Forage quadrats were clipped from the grazed and ungrazed portions of each pasture to determine weekly forage mass. Total ergot alkaloid (TEA) concentrations were analyzed for all pastures at the beginning of the experiment and every subsequent 2 wk for E+ tall fescue. Cow BW was recorded on 2 consecutive d and BCS determined at the start and end of the experiment. In yr 2, ultrasound 12th rib fat thickness (FT) was measured at the beginning and end of the treatment period Milk production was estimated using the weigh-suckle-weigh technique at 29 ± 14 d postpartum. Initial TEA concentrations for NE (Yr. 1 = 112 µg/kg; Yr. 2 = 632 µg/kg) were decreased (P ≤ 0.01) compared to E+ (Yr. 1 = 1831 µg/kg; Yr. 2 = 2903 µg/kg). TEA concentrations for E+ pastures did not differ (P < 0.23) by sample date. However, average TEA concentrations were greater for yr 2 than yr 1(P ≤ 0.01). Fescue cultivars were not different (P ≥ 0.06) in forage CP, Ash, Ether Extract, and grazed or ungrazed forage mass. However, differences were observed (P ≤ 0.02) for ADF, NDF, and TDN by fescue cultivar. Cow BW, BCS, and FT at the beginning and end of grazing were not different (P ≥ 0.41) by treatment. Milk production was greater (P < 0.01) for cows grazed on E+. Calving date, calf BW, calf ADG were not different (P ≥ 0.65) by treatment. Neither AI nor overall conception rates differed (P ≥ 0.23) between cultivars. Performance of fall-calving cows pre-exposed to E+ was not hindered when grazed on E+ relative to NE in a SS system. / Master of Science / Wild-type, endophyte-infected tall fescue (E+) is the predominant forage of use for producers within the southeastern United States. Endophyte-infected tall fescue gained notoriety due to its drought and pest resistance as well as climate adaptability. These advantages are the result of a symbiotic relationship with an endophytic fungus that has been shown to decrease in animal performance through the production of toxic ergot alkaloids. Development of improved fescue cultivars provided producers with an alternative forage, known as novel endophyte-infected tall fescue (NE), that maintains the agronomic advantages noted with E+ fescue without negative impacts on animal gain and reproductive performance. In adopting NE tall fescue, producers are faced with the financial challenge of renovating existing stands of E+ with NE fescue; leaving pastures unusable during times of normal grazing behavior. This constraint has highlighted the need to explore forage utilization and strategies that can extend the grazing period that do not require the significant cost of total renovation with NE. Fall stockpiled tall fescue has provided producers an option to extend grazing from late November through February when pasture growth ceases and hay supplementation is normally needed. However, a 60 to 90 d period between summer and fall stockpiled grazing leaves producers looking for an additional strategy to provide standing forage for their herds. Summer stockpiling (SS), is a novel grazing strategy that bridges summer and fall stockpiled grazing through proper accumulation of 25 % of total pasture to help extend producers grazing season. The objective of the current experiment is to evaluate both E+ and NE SS pastures and its effect on animal performance, forage availability, and nutritive value. Cow BW and BCS were measured at the initiation, conclusion, and before artificial insemination. Calf BW and ADG were assessed 48 h post-calving and at weaning. Ungrazed and grazed forage mass was collected weekly, while measurements of ADF, NDF, CP, TDN, ether extract, and ash were measured every 2 weeks. After a 52 d treatment period, forage mass was similar across both cultivars, with ADF, NDF, and TDN favoring E+ tall fescue. Additionally, animal performance across both E+ and NE pastures were similar, however increased milk production was observed for cows grazed on E+. This experiment helps shed light on the concept of strategic renovation. Strategic renovation can be best utilized by producers who are interested in maximizing pasture utilization through rotationally grazing E+ and NE tall fescue pastures. By following this renovation strategy, proper allocation of NE tall fescue during times of enhanced ergotism and E+ tall fescue during low thresholds will develop a more specific rotation thus decreasing renovation costs for producers when ergotism is lowest.

Thesis (MScMedSc))--Stellenbosch University, 2012. / Includes bibliography / ENGLISH ABSTRACT: Despite the availability of Hepatitis B virus (HBV) vaccination for over three decades, this infection remains a major public health problem. Whilst the WHO recommends giving a birth dose of the vaccine, in South Africa, routine infant HBV vaccination commences at six weeks of age. This schedule is based on data from the pre-HIV era which showed transmission occurred via the horizontal, rather than the vertical route. In the era of HIV however, maternal HIV co-infection may release HBV from immune control, resulting in higher HBV loads and increasing the risk of vertical transmission. The aim of this study was to determine the prevalence and character of HBV infection in HIV-exposed infected and uninfected infants. Residual plasma samples from routine HIV nucleic acid testing of 1000 HIV-exposed infants aged between 0 and 18 months from the Western Cape were tested. Samples were tested for HBsAg by ELISA (Murex HBsAg Version 3) and confirmed by neutralisation. HBV DNA was quantified using an in-house real-time PCR assay. Infants with HBsAg positive samples were followed up and a blood sample was collected from mother and child. Those HBsAg positive samples were tested for HBeAg/antiHBe (Diasorin) and HBsAg negative samples were tested for antiHBs. HBV DNA was quantified. The surface gene was sequenced and the HBV genotype determined by phylogenetic analysis using HepSEQ (www.hepseq.org.uk). Whole genome sequencing was also performed. Of 1000 samples tested, four samples were positive for HBsAg and/or HBV DNA, indicating a prevalence of HBV transmission of 0.4%. At follow-up, two of three infected infants were positive for HBsAg, with HBV viral loads of greater than 108 IU/ml. The third infant was found to have cleared his infection and the fourth child was lost to follow up. These infected infants had all received HBV vaccination. All four mothers were HBeAg positive. Sequencing analysis showed the HBV strains from the two infants and four mothers belonged to subgenotype A1. The two mother-child paired sequences were identical. The data from this study shows that vertical transmission of HBV infection in HIV-exposed infants from the Western Cape is occurring, despite vaccination. Data from the Western Cape, showing an HBV prevalence of 3.4% in HIV-infected pregnant women, and those presented here suggest a vertical transmission rate of HBV of 12%. This is despite the widespread use of tenofovir and lamivudine in HIV-infected women with low CD4 counts. This study provides data supporting calls to bring HBV vaccination closer to the time of birth. Further work is urgently needed to confirm these findings and to determine the rates of transmission in HIV-unexposed infants. / AFRIKAANSE OPSOMMING: Ten spyte van die beskikbaarheid van die Hepatitis B virus (HBV) inenting vir meer as drie dekades, hierdie infeksie bly 'n groot openbare gesondheid probleem. Terwyl die WGO aan beveel dat'n geboorte dosis van die entstof, in Suid-Afrika, roetine baba HBV inenting op die ouderdom van ses weke gegee word. Hierdie skedule is gebaseer op data van die pre-MIV era wat getoon het dat die oordrag plaasgevind het via die horisontale, eerder as die vertikale roete. In die era van MIV egter, moeder MIV ko-infeksie kan HBV vrylaat van immuun beheer, wat lei in hoër HBV vlakke en die verhoging van die risiko van vertikale oordrag. Die doel van hierdie studie was om die voorkoms en karakter van die HBV infeksie in MIV-besmette en onbesmette babas te bepaal. Residuele plasma monsters van roetine-MIV-nukleïensuur toetse van 'n 1000 MIV-blootgestelde babas tussen die ouderdomme van 0 en 18 maande van die Wes-Kaap was getoets. Monsters was getoets vir HBsAg deur ELISA (Murex HBsAg Version 3) en bevestig deur neutralisering. HBV DNA is gekwantifiseer deur gebruik te maak van 'n in-huis real-time PCR assay. Babas met HBsAg positiewe monsters was opgevolg en 'n bloedmonster is versamel van moeder en kind. Die HBsAg positiewe monsters was getoets vir HBeAg/antiHBe (Diasorin) en HBsAg negatiewe monsters was getoets vir antiHBs. HBV DNA was gekwantifiseer. Die oppervlak gene volgorde en genotipes was bepaal deur filogenetiese analise met behulp van HepSEQ (www.hepseq.org.uk). Die hele genoom-volgordebepaling was ook uitgevoer. Van die 1000 monsters wat getoets was, was vier monsters positief vir HBsAg en of HBV DNA, dit dui op 'n voorkoms van HBV oordrag van 0.4%. By op volg, twee van die drie besmette babas was positief vir HBsAg, met HBV virale vlakke van groter as 108 IE/ml. Die derde baba was gevind dat sy infeksie opgeklaar het en die vierde kind was verlore as gevolg van op volg. Hierdie besmette babas het almal HBV inenting ontvang. Al vier moeders was HBeAg positief. Volgordebepaling analise het getoon die HBV stamme van die twee babas en vier moeders behoort aan subgenotype A1. Die twee moeder-kind gepaarde rye was homoloë. Die data van hierdie studie toon dat die vertikale oordrag van HBV infeksie in MIV-blootgestelde babas van die Wes-Kaap vind plaas, ten spyte van inenting. Data van die Wes-Kaap, wat 'n HBV voorkoms van 3.4% in MIV-besmette swanger vroue, en dié wat hier aangebied is dui op 'n vertikale oordrag koers van 12% van die HBV. Dit is ten spyte van die wydverspreide gebruik van tenofovir en lamivudine in MIV-geïnfekteerde vroue met 'n lae CD4-telling. Hierdie studie bied data wat ondersteunende oproepe van HBV inenting nader aan die tyd van die geboorte bring. Verdere werk is dringend nodig om die bevindinge te bevestig en die pryse van die oordrag in MIV-blootgestelde babas te bepaal. / National Health Laboratory Service Research Trust / Poliomyelitis Research Foundation (PRF) / Harry Crossley Foundation / Stellenbosch University

Thesis (MScMedSc)--Stellenbosch University, 2012. / Bibliography / ENGLISH ABSTRACT: Background: In the era of antiretroviral therapy (ART), the risk of acquired immune deficiency syndrome (AIDS) related deaths has decreased and people living with Human Immunodeficiency Virus (HIV) now have prolonged life spans. However, an increasing trend of non-AIDS associated deaths has been reported despite adequate control of viral loads. HIV infection is established as a chronic inflammatory condition which is associated with an increased risk for thrombosis. Thus HIV infected patients are at a higher risk of developing cardiovascular disease (CVD) and other inflammatory-associated complications. Inflammation is linked with thrombosis and promotes the formation of thrombin, which plays an important role in platelet activation. Furthermore, activated platelets have been shown to play a key role during infection and the inflammatory process, particularly by mediating interactions between cells of innate immunity. Soluble markers of platelet activation have been shown to be increased in HIV-infection. However, these have not been well documented by flow cytometry. P-selectin CD62P is stored in the alpha granules of platelets and is expressed on the surface only upon platelet activation. This facilitates interaction with other blood cells and the endothelium. Activated platelets may play a role in HIV-induced atherosclerosis through the expression and release of mediators that induce endothelial activation and support the adhesion of leukocytes to the inflamed vessel wall. Fibrinogen is a precursor of the blood coagulatory protein fibrin and the degradation of fibrin to D-dimer is a measure of the formation and the subsequent dissolution of blood clots. In HIV infected patients, chronic inflammation induces the up-regulated expression of tissue factor (TF) on monocytes which triggers the activation of the clotting cascade and increases the level of D-dimers. Methods: This pilot study consisted of ART naïve patients and all platelet flow analyses were carried out on whole blood. In this study, a total of 57 adult South Africans were recruited from a clinic in the Western Cape. These included 32 HIV positive patients and 25 HIV negative individuals. The levels of platelet activation and platelet function were investigated using a novel platelet cytometry assay. The method was optimized to ensure minimal platelet activation: no centrifugation or red blood cell (RBC) lysis steps were performed. The platelet-specific markers CD41a and CD42b were used to ensure gating on platelets only. CD62P expression was used to evaluate platelet activation and these levels were correlated with Fibrinogen, hsCRP, Ddimer, CD4 counts and viral load. Furthermore, platelet function was evaluated by investigating the response of platelets to endogenous agonists which included adenosine diphosphate(ADP) and arachidonic acid (AA) at varying concentrations. Results:This study demonstrated higher baseline levels of CD62P expression in treatment naïve HIV positive patients as compared to uninfected controls (mean %CD62P 71.74 ± 2.18 vs control 54.52 ± 2.42; p=<0.0001). In addition it was shown that %CD62P expression correlated directly with platelet counts (r=0.374, p=0.042). Platelet counts showed an inverse correlation with viral loads (give values) Fibrinogen levels correlated with the absolute WCC (r=0.659, p=0.0021); absolute neutrophil count (r=0.619, p=0.0105); absolute monocyte count (0.562, p=0.0235) and hsCRP (r=0.688 p=0.0011). In addition, fibrinogen showed a strong negative correlation with CD4 counts (r=-0.594, p=0.0014) and therefore, may be a valuable marker of both disease progression and risk of thrombosis in treatment naïve HIV positive patients. HsCRP levels correlated with the absolute neutrophil counts (r=0.392, p=0.0005). The HIV Group showed an overall hyper-response to ADP at a concentration 0.025 μM as compared to uninfected controls (62.34 ± 9.7 vs control 36.90 ± 5.7, p=0.0433). Conclusions: In this study we describe a novel Flow Cytometry technique that may be used to evaluate the levels of platelet activation and platelet function in HIV infected patients. In addition we report a cost-effective panel in the form of fibrinogen, WCC and platelets that may be valuable in predicting the progression of HIV infection to AIDS or other inflammatory- associated complications in treatment naïve HIV infected patients. Platelet counts showed an inverse correlation with viral loads and a direct correlation with the level of activated platelets. These findings taken together suggest the potential prognostic value of platelet activation and platelet counts in the context of asymptomatic HIV infected patients. Our findings suggest WCC and Fibrinogen may be used to evaluate the inflammatory profile of individual HIV infected patients. This may have a direct impact on HIV patient management prior to initiation of antiretroviral therapy and valuable in monitoring responses to treatment. Further, we present a novel flow cytometry based platelet functional assay and suggest the use of ADP at a concentration of 0.025 μM to evaluate platelet function optimally in HIV infected patients. The utilization of the novel Flow Cytometry technique as described in this study would add significant value in the assessment of thrombotic risk and disease progression in HIV infected patients and may additionally prove to be of value in other chronic inflammatory conditions. / AFRIKAANSE OPSOMMING: Voorkennis: In die era van antiretrovirale terapie (ART), het die risiko van vigs-verwante sterftes verminder en mense wat nou met volle naam (MIV) leef, het ‘n verlengde lewensduur. Nogtans, word 'n toenemende neiging van nie-vigs geassosieer sterftes berig wat hoofsaaklik toegeskryf word aan trombotiese toestande. MIV-infeksie word as 'n chroniese inflammatoriese toestand beskou met ʼn verhoogde trombose risiko geassosieer word. Dus, MIV-besmette pasiënte het 'n hoër risiko om kardiovaskulêre siekte (CVD) te ontwikkel ongeag of hulle ARV naïef is of op behandeling is nie. Inflammasie word geassosieer met trombose en bevorder die vorming van trombien, wat 'n belangrike rol in plaatjie aktivering speel. Verder, word daar bewys dat geaktiveerde bloedplaatjies 'n belangrike rol speel tydens infeksie en die inflammatoriese proses.Hulle bemiddel interaksies tussen die selle van ingebore immuniteit. Daar word bewys dat oplosbare merkers van plaatjie aktivering verhoog is in MIV-infeksie, maar die bewyse is nie so goed gedokumenteer deur vloeisitometrie nie. P-selectin (CD62P) word gestoor in die alfa korrels van plaatjies en word uitgedruk op die oppervlak slegs wanneer plaatjies geaktivering word; daardeur fasilitering dit die interaksie met ander bloedselle en die endoteel. Geaktiveerde plaatjies kan ook 'n rol in MIV-geïnduseerde aterosklerose speel deur middel van die uitdrukking en vrylating van bemiddelaars wat endoteel aktivering induseer asook die adhesie van leukosiete aan die ontsteekte vat wand ondersteun.. Fibrinogeen, 'n voorloper van die bloed koagulatories proteïen fibrin en die degradasie van fibrin na D-dimeer is' n maatstaf van die vorming en die daaropvolgende ontbinding van bloedklonte. Kroniese inflammasie in MIVbesmette pasiënte, induseer die op-gereguleerde uitdrukking van weefsel faktor (TF) op monosiete wat die aktivering van die stolling kaskade inisieer en die D-dimere vlakke verhoog. Metodes: Hierdie loodsstudie bestaan uit ART naïewe pasiënte en al die plaatjie vloei ontleding was op vol bloed uitgevoer. In hierdie studie, 'n totaal van 57 volwasse Suid-Afrikaners was van' n kliniek in die Wes-Kaap gewerf. Dit sluit 32 MIV-positiewe pasiënte en 25 MIV negatiewe individue in. Die vlakke van plaatjie aktivering en plaatjie funksie was ge ondersoek deur middel van 'n nuwe plaatjie sitometrie toets. Die metode was geoptimaliseer om minimale plaatjie aktivering te verseker: dus geen sentrifugering of volle naam (RBS) liseer stappe was gebruik nie. Die plaatjie-spesifieke merkers, CD41a en CD42b was gebruik om te verseker dat slegs bloedplaatjes gekies word. Die uitdrukking van CD62P was gebruik vir die evaluering van plaatjie aktivering en hierdie vlakke was gekorreleer met fibrinogeen, hsCRP, D-dimeer, CD4- tellings en virale lading. Verder, was plaatjie funksie geëvalueer deur die reaksie van plaatjies aan endogene agoniste wat ADP en AA by wisselende konsentrasies insluit te ondersoek. Results: Hierdie studie het getoon hoër basislyn vlakke van CD62P uitdrukking in behandeling naïewe MIV-positiewe pasiënte in vergelyking met onbesmette beheermaatreëls (beteken% CD62P 71,74 ± 2,18 vs beheer 54,52 ± 2,42, p <0.0001). Daar is ook getoon dat% CD62P uitdrukking direk gekorreleer met plaatjie tellings (r = 0,374, p = 0,042). Plaatjie tellings het 'n omgekeerde korrelasie met virale ladings (gee waardes) fibrinogeen vlakke korreleer met die absolute WCC (r = 0,659, p = 0,0021), absolute neutrofiel telling (r = 0,619, p = 0,0105); absolute monosiet telling (0,562, p = 0,0235) en hsCRP (r = 0,688 p = 0,0011). Daarbenewens, fibrinogeen het 'n sterk negatiewe korrelasie met 'n CD4-tellings (r = -0,594, p = 0,0014) en daarom kan 'n waardevolle merker van beide die siekte en die risiko van trombose in behandeling naïewe MIV-positiewe pasiënte. HsCRP vlakke gekorreleer met die absolute neutrofiel tellings (r = 0,392, p = 0,0005). Die MIV-groep het 'n algehele hiper-reaksie op die ADP by 'n konsentrasie 0,025 μM in vergelyking met onbesmette beheermaatreëls (62,34 ± 9,7 vs beheer 36,90 ± 5.7, p = 0,0433). Gevolgtrekkings: In hierdie studie beskryf ons 'n roman vloeisitometrie tegniek wat gebruik kan word om die vlakke van Plaatjie aktivering en plaatjie funksie in die MIV-besmette pasiënte te evalueer. Verder het ons 'n verslag van 'n koste-effektiewe paneel in die vorm van fibrinogeen, WCC en plaatjies wat waardevol kan wees in die voorspelling van die vordering van MIVinfeksie tot VIGS of ander inflammatoriese-verwante komplikasies in die behandeling naïewe MIV-besmette pasiënte. Plaatjie tellings het 'n omgekeerde korrelasie met die virale laste en 'n direkte verband met die vlak van geaktiveerde bloedplaatjies. Hierdie bevindinge saam, dui op die moontlike prognostiese waarde van Plaatjie aktivering en die plaatjie tel in die konteks van die asimptomatiese MIV-geïnfekteerde pasiënte. Ons bevindinge dui daarop WCC en fibrinogeen kan gebruik word om die inflammatoriese profiel van individuele MIV-geïnfekteerde pasiënte te evalueer. Dit kan 'n direkte impak op MIV pasiënt vooraf aan die inisiasie van antiretrovirale terapie en waardevolle in die monitering van die reaksie op behandeling. Verder bied ons 'n roman vloeisitometrie gebaseer plaatjie funksionele toets en dui op die gebruik van die ADP teen 'n konsentrasie van 0,025 μM plaatjie funksie optimaal te evalueer in MIVgeïnfekteerde pasiënte. Die benutting van die roman vloeisitometrie tegniek soos beskryf in hierdie studie sal 'n beduidende waarde toevoeg in die beoordeling van die die trombotiese risiko en die siekte in MIV-geïnfekteerde pasiënte en kan addisioneel bewys van waarde te wees in 'n ander chroniese inflammatoriese toestande. / National Reserach Foundation

Made available in DSpace on 2016-03-15T19:37:27Z (GMT). No. of bitstreams: 1 Davi de Oliveira Gerardi.pdf: 2216694 bytes, checksum: 5c92a695124c5b7d9e20de8329020701 (MD5) Previous issue date: 2010-08-02 / SIS (susceptible-infected-susceptible) and SIR (susceptible-infectedremoved) epidemiological models based on probabilistic cellular automaton (PCA) are used in order to simulate the temporal evolution of the number of people infected by dengue in the city of Rio de Janeiro in 2007, and to predict the cases of infection in 2008. In the PCA, three different sizes of lattices and two kinds of neighborhoods are utilized, and each time step of simulation is equivalent to one week of real time. A genetic algorithm (GA) is employed to identify the probabilities of the state transition S&#8594;I, in order to reproduce the historical series of 2007 related to this disease propagation. These probabilities depend on the number of infected neighbors. Time-varying and constant probabilities are taken into account. These models based on PCA and GA were able of satisfactorily fitting the data from 2007 and making a good prediction for 2008 (mainly about the total number of cases registered during 2008). / Usam-se modelos epidemiológicos SIS (suscetível-infectado-suscetível) e SIR (suscetível-infectado-removido) baseados em autômato celular probabilista (ACP) a fim de simular a evolução temporal do número de pessoas infectadas por dengue, na cidade do Rio de Janeiro em 2007, e de prever os casos de infecção em 2008. No ACP, utilizam-se reticulados de três tamanhos diferentes e dois tipos de vizinhanças, e cada passo de tempo da simulação equivale a uma semana de tempo real. Emprega-se um algoritmo genético (AG) para identificar os valores das probabilidades da transição de estados S&#8594;I, de modo a reproduzir a série histórica de 2007 relacionada à propagação dessa doença. Essas probabilidades dependem do número de vizinhos infectados. Probabilidades variantes e invariantes no tempo são consideradas. Esses modelos baseados em ACP e AG foram capazes de fazer um ajuste satisfatório dos dados de 2007 e de fornecerem uma boa previsão para 2008, (principalmente no que diz respeito ao número total de casos registrados em 2008).

The aim of this study was to explore, describe and interpret the experiences of Immunodeficiency Human Virus (HIV) infected mothers regarding exclusive breastfeeding in the first six months of the infant’s life. This was a qualitative study with phenomenology as a design as the study was about lived experiences. The sample consisted of HIV infected mothers aged 18 years and above who opted for exclusive breastfeeding for the first six months of their infant’s lives. Purposive sampling was used. Data was collected through one to one semi structured interviews of fifteen mothers of babies aged six to twelve months. The study revealed that mothers had both positive and negative experiences which were influenced by among others; the level of support the mothers received, disclosure of HIV status and health education received at the health facility. The findings of the study revealed a low level of understanding of the Infant and Young Child Feeding Policy by health professionals / Health Studies / M.A. (Health Studies)