No description available.

Body fluid identification is important in the field of forensic science as it can provide valuable information to an investigation. An accurate method for detecting blood at a crime scene or on evidence is beneficial to an analyst or investigator. A piece of evidence may be any house-hold object or material; therefore, a test must be able to accurately detect blood on a variety of substrates. The most common preliminary testing method for blood is based on the peroxidase-like activity of hemoglobin. Tests such as phenolphthalein (Kastle-Meyer), Ortho-Tolidine (O-Tol), and Luminol utilize this method. The sensitivity of presumptive blood tests was evaluated using a series of diluted bloodstains on six fabrics: fleece, felt, linen, denim, flannel, and terrycloth. In addition to a direct testing method, two indirect methods were tested utilizing a piece of dry filter paper or a moistened cotton swab. The last portion of this study compared commercial field kits to the laboratory-prepared reagents. This study yielded overall sensitivities for Kastle-Meyer, O-Tol, and Luminol of 1:1000, 1:5000, and 1:10000, respectively. The direct testing resulted in a slightly lower sensitivity with fleece versus the other fabrics. Fleece also resulted in slower and weaker reactions compared to thinner fabrics such as denim, linen, and terrycloth. This suggests that highly absorbent fabrics, such as fleece, can have a negative effect on the sensitivity of catalytic color tests such as Kastle-Meyer and O-Tol. The indirect testing methods utilizing a moistened swab or a dry filter paper were less sensitive compared to direct testing methods. The field kits tested in this study mimic the methods of a moistened swab technique, and the results demonstrated that the field kits were about the same sensitivity or less sensitive compared to the indirect testing methods.

Invasive fungal infections (IFIs) are associated with considerable morbidity and mortality among high-risk individuals. Outcomes for IFI historically have been suboptimal and associated with a high mortality rate, hence global prophylaxis strategies have been applied to at-risk populations. Among certain populations, fluconazole prophylaxis has reduced systemic and superficial infections caused by Candida species. Newer azoles are currently being evaluated as prophylaxis and have the potential to provide protection against mould pathogens that are more troublesome to treat once they occur. Global prophylaxis strategies have the shortcoming of subjecting patients to therapy that ultimately will not need it. Targeted prophylaxis has the advantage of treating only patients at highest risk using some parameter of greater host susceptibility. Prophylaxis strategies are most suitable in patients at the highest risk for IFI. For patient groups whose risk is somewhat lower or when suspicion of IFI occurs in patients receiving prophylaxis, empirical antifungal therapy is often employed following a predefined period of fever. Again this approach subjects many non-infected patients to unnecessary and toxic therapy. A more refined approach such as presumptive or pre-emptive therapy whereby treatment is only initiated upon positive identification of a surrogate marker of infection in combination with clinical and radiological signs will subject fewer patients to toxic and expensive treatments.

No description available.

A matéria das presunções no direito relembra condições da própria gênese do sistema jurídico. Toda linguagem normativa comparece a princípio como raciocínio ou juízo presuntivo simples. No lidar com os casos concretos, primitivamente é o exegeta autêntico que faz introduzir no ordenamento fatos, presumindo ocorrências da realidade empírica. E o sistema jurídico pode optar em regular conduta topologicamente por meio de presunções realizadas pelo aplicador da ordem posta ou pelas Casas Legislativas. Assumidas enquanto normas, as presunções são signos linguísticos, que, com o apoio dos recursos semióticos, podem ser analisados sob três enfoques: sintático; semântico e pragmático. O ângulo sintático requer seja ressaltado o signo segundo sua formação unitária, observando-se sua estrutura fundante e a forma com que se apresenta aos nossos olhos. Sem perder de vista seu caráter uno, examinamo-lo em face das relações mútuas que mantém com outros signos, dentro e fora de seus sistemas de referência. Do ponto de vista semântico, observa-se a relação do signo com o objeto que representa. Acham-se as modulações de seu conteúdo, tendo em vista, de um lado, o objeto que quer ver representado em termos linguísticos e, de outro, o contexto no qual se insere. Indaga-se, portanto, sobre seus significados. Por fim, no campo pragmático, revela os usos linguísticos das presunções em uma dada sociedade, sobressaltando as variações de sentido originárias da dinâmica do sistema. A pragmática do signo o coloca em ação, observando-o no decorrer do tempo. Buscando expor as minúcias das presunções subdividindo a análise nesses três campos do conhecimento é que se pretende, entre outras coisas, eliminar as confusões que envolvem o tema, ressaltando o seu caráter jurídico e negando conjecturas de outras ordens para explicá-las (como as da política do direito, da sociologia ou da psicologia). Quer-se com isso alcançar precisão do termo no sistema jurídico, mediante (i) exigente rigor terminológico; (ii) precisão conceptual; e (iii) no uso de técnica de sistematização inexcedível pautada na dogmática jurídica. Enfim, busca-se imprimir unidade ao instituto das presunções no âmbito fiscal. E todo esse trabalho se o faz revigorando o tema segundo as contribuições da análise filosófica de teoria de linguagem, da semiótica e da Teoria Geral do Direito, com o fim específico de fundamentar uma teoria da ciência positiva das presunções no direito tributário. / The issue of presumptions in law reminisces the conditions of the legal systems own genesis. All statutory language first appears as reasoning or a simple presumptive judgment. In dealing with individual cases, at first it is the authentic exegete who introduces the facts in the juridical system by presuming occurrences of empirical reality. The legal order can opt to rule topological conducts by assumptions made by the juridical authority or the Legislative Chambers. Taken as juridical norms, the presumptions are linguistic signs that, with the support of semiotic resources, can be analyzed from three perspectives: syntactic, semantic and pragmatic. The syntactic angle requires the emphasis in the signs according to its unity formation by observing its founding structure and the way that it presents itself in our eyes. Without losing sight of this singular characteristic, we examine it in light of the relation it has with other signs, in and out of their system of reference. In the semantic point of view, we observe the relationship of the sign with the object that it represents. We find modulations of its content, observing in one hand, the object that it wants to see represented in linguistic terms and on the other hand, the context in which it operates. We wonder, therefore, about the or its meaning. Finally, the pragmatic domain reveals the linguistic use of presumptions in a given society, highlighting the changes of meanings given by the systems dynamics. The pragmatic of the sign puts it in action observing it over time. By subdividing the analysis in these three fields of knowledge, the intention is to expose the minutiae of presumptions and to eliminate the confusion around the theme amongst others. This can be achieved by emphasizing its juridical characters of presumptions and refusing conjectures of other orders to explain them (as politics, sociology or psychology). The purpose is to achieve precision of the term in the legal system by (i) demanding rigorous terminology, (ii) conceptual clarity and (iii) use of technical systematization unsurpassed ruled in legal dogmatic. All this work is reinvigorating by contributions of philosophical analysis of language theory, semiotics and the General Theory of law, for the specific purpose of supporting a theory of the presumptions in tax law.

A matéria das presunções no direito relembra condições da própria gênese do sistema jurídico. Toda linguagem normativa comparece a princípio como raciocínio ou juízo presuntivo simples. No lidar com os casos concretos, primitivamente é o exegeta autêntico que faz introduzir no ordenamento fatos, presumindo ocorrências da realidade empírica. E o sistema jurídico pode optar em regular conduta topologicamente por meio de presunções realizadas pelo aplicador da ordem posta ou pelas Casas Legislativas. Assumidas enquanto normas, as presunções são signos linguísticos, que, com o apoio dos recursos semióticos, podem ser analisados sob três enfoques: sintático; semântico e pragmático. O ângulo sintático requer seja ressaltado o signo segundo sua formação unitária, observando-se sua estrutura fundante e a forma com que se apresenta aos nossos olhos. Sem perder de vista seu caráter uno, examinamo-lo em face das relações mútuas que mantém com outros signos, dentro e fora de seus sistemas de referência. Do ponto de vista semântico, observa-se a relação do signo com o objeto que representa. Acham-se as modulações de seu conteúdo, tendo em vista, de um lado, o objeto que quer ver representado em termos linguísticos e, de outro, o contexto no qual se insere. Indaga-se, portanto, sobre seus significados. Por fim, no campo pragmático, revela os usos linguísticos das presunções em uma dada sociedade, sobressaltando as variações de sentido originárias da dinâmica do sistema. A pragmática do signo o coloca em ação, observando-o no decorrer do tempo. Buscando expor as minúcias das presunções subdividindo a análise nesses três campos do conhecimento é que se pretende, entre outras coisas, eliminar as confusões que envolvem o tema, ressaltando o seu caráter jurídico e negando conjecturas de outras ordens para explicá-las (como as da política do direito, da sociologia ou da psicologia). Quer-se com isso alcançar precisão do termo no sistema jurídico, mediante (i) exigente rigor terminológico; (ii) precisão conceptual; e (iii) no uso de técnica de sistematização inexcedível pautada na dogmática jurídica. Enfim, busca-se imprimir unidade ao instituto das presunções no âmbito fiscal. E todo esse trabalho se o faz revigorando o tema segundo as contribuições da análise filosófica de teoria de linguagem, da semiótica e da Teoria Geral do Direito, com o fim específico de fundamentar uma teoria da ciência positiva das presunções no direito tributário. / The issue of presumptions in law reminisces the conditions of the legal systems own genesis. All statutory language first appears as reasoning or a simple presumptive judgment. In dealing with individual cases, at first it is the authentic exegete who introduces the facts in the juridical system by presuming occurrences of empirical reality. The legal order can opt to rule topological conducts by assumptions made by the juridical authority or the Legislative Chambers. Taken as juridical norms, the presumptions are linguistic signs that, with the support of semiotic resources, can be analyzed from three perspectives: syntactic, semantic and pragmatic. The syntactic angle requires the emphasis in the signs according to its unity formation by observing its founding structure and the way that it presents itself in our eyes. Without losing sight of this singular characteristic, we examine it in light of the relation it has with other signs, in and out of their system of reference. In the semantic point of view, we observe the relationship of the sign with the object that it represents. We find modulations of its content, observing in one hand, the object that it wants to see represented in linguistic terms and on the other hand, the context in which it operates. We wonder, therefore, about the or its meaning. Finally, the pragmatic domain reveals the linguistic use of presumptions in a given society, highlighting the changes of meanings given by the systems dynamics. The pragmatic of the sign puts it in action observing it over time. By subdividing the analysis in these three fields of knowledge, the intention is to expose the minutiae of presumptions and to eliminate the confusion around the theme amongst others. This can be achieved by emphasizing its juridical characters of presumptions and refusing conjectures of other orders to explain them (as politics, sociology or psychology). The purpose is to achieve precision of the term in the legal system by (i) demanding rigorous terminology, (ii) conceptual clarity and (iii) use of technical systematization unsurpassed ruled in legal dogmatic. All this work is reinvigorating by contributions of philosophical analysis of language theory, semiotics and the General Theory of law, for the specific purpose of supporting a theory of the presumptions in tax law.

Master of Public Health - MPH / Background: In South Africa, tuberculosis (TB) detection remains a major problem, as notified cases are estimated to account for only 68% of all incident cases. Health services have relied on passive case finding and this leads to missed or delayed diagnosis. In Cape Town, City Health has embarked on an active surveillance programme to systematically screen all adults seeking health care at PHC facilities for active TB, in order to identify undiagnosed incident TB cases and avert missed opportunities for treating TB. Aim: The aim of this study was to evaluate the effects of an intensified TB screening strategy on changes in facility level TB case finding in City Health PHC facilities in Cape Town.

Magister Public Health - MPH / In Zambia, there had been a large scaling up of new interventions to control malaria since 2003, which included the distribution of rapid diagnostic tests (RDTs), used to immediately determine if someone with symptoms suggestive of malaria actually has malaria; training of health workers in the use of the RDTs; and the prescription of artemisinin-based combination therapy (ACT) to which the malaria parasite is sensitive, rather than the old treatment regime of chloroquine to which the malaria parasite had become resistant. The use of RDTs to confirm the presence of malaria before treating for it with ACT became known as the „test and treat‟ policy. Previously, since the 1960s, in malaria endemic areas such as Zambia, children presenting with fever (the commonest symptom of malaria) without any obvious other cause for the fever, were assumed to have malaria and were hence treated for it with chloroquine. This was known as "presumptive treatment" of malaria. The combination of "presumptive treatment" and the use of a single medication led to the development of high levels of resistance to chloroquine, to the extent that it is now no longer an effective treatment for malaria. Years after the introduction of the "test and treat" policy, it was still unclear to what extent it was being implemented, as there was initial reluctance by health workers to test all children presenting with fever for malaria and if they did test they may not have followed the management guidelines of treating those who test positive with ACT and further investigating those who test negative for the cause of the fever. It seemed that staff had gotten used to the "presumptive treatment" approach to malaria over almost 4 decades and hence were quite reluctant to abandon it. The conflicting guidelines for malaria treatment in children between IMCI and "test and treat‟ has promoted a paradox between presumptive treatment for malaria and "test and treat" approach as IMCI teaches health workers to treat febrile children presumptively for malaria whereas the "test and treat" approach requires them to first make a definitive diagnosis before treating. Hence although the "test and treat" approach was instituted to overcome the problems with presumptive treatment approach it now had to contend with the competing and contradictory influence of the IMCI approach. This study therefore aimed to assess what proportion of children aged five years and younger who presented with fever were managed via the "test and treat" guidelines and which factors were associated with this, in Lusaka District, Zambia. Methodology: A cross sectional analytical study design was used based on a review of medical records. A sample size of 800 medical records of children presenting with fever was selected from 10 out of the 23 health care facilities in Lusaka, using a multistage stratified random sampling technique. Four hundred records were sampled from 2008 records (five years after commencement of the "test and treat" policy) and 400 from 2011 records (eight years after commencement of the "test and treat" policy). Trained data collectors used a data extraction tool to transcribe demographic and clinical data from the medical records in a standardized manner. Data Analysis: Univariate descriptive statistics analysis was performed using measures of central tendency and measures of dispersion to analyze numerical (continuous) variables such as age, weight and body temperature; and using frequencies for categorical variables such as gender, area of residence, RDTs/microscopy malaria tests conducted, received ACT if RDT positive, presence of an ACT treatment chart on the health centre wall and availability of a weighing scale. To determine the relationship between variables, bivariate analysis via the prevalence ratio was conducted. Results: Just over half (55%) of all children with fever were tested for malaria in 2008 and this gratifyingly increased to (73%) in 2011. Overall, the proportion of children correctly and appropriately treated with ACT, which means that those who tested positive for malaria were given ACT, was 85% in 2008 but regrettably dropped to 72% in 2011. Although "presumptive treatment" decreased from 24% in 2008 to 11% in 2011, the proportion of children with fever not tested for malaria, and although not treated for malaria, but left without a definitive diagnosis of their fever being made, remained high but dropping (22% in 2008 and 16% in 2011). Similarly the proportion of children who tested negative for malaria but then did not undergo any further investigation also unfortunately remained very high and rising (57% in 2008 and 89% in 2011). A combination of the above poor clinical management practises resulted in only 38% of children with fever in 2008 and unfortunately dropping to only 33% in 2011 being correctly managed (tested for malaria via RDT or microscopy and treated with ACT if positive, while further investigated for the cause of fever if negative). On preparedness of the health facility to implement the "test and treat" policy, it was noted that only 4 out of 10 health facilities were at least minimally prepared to do so, but paradoxically on bivariate analysis those minimally prepared were less likely (PR 0.62; 95% CI 0.41-0.94) to correctly manage the patients in 2011 than those who were unprepared. A similar paradox occurred for those correctly treated with ACT after testing positive, with facilities which were minimally prepared being less likely to do so (PR 0.28; 95% CI 0.14-0.58) in 2011 than those facilities which were unprepared to implement the "test and treat" policy. However these associations were inconsistent over time, as the associations were not present in 2008. Similarly all other factors such as staff category (doctor, nurse, clinical officer) and type of presenting symptoms besides fever (anorexia, lethargy, pallor) assessed, were not consistently associated with testing for malaria in both 2008 and 2011. The same applied for the other two main outcome variables of 'treated with ACT after test positive for malaria' and 'correctly managed child with fever', in that there were no factors that showed a consistent association with them in both 2008 and 2011. Conclusion: Testing of children with fever for malaria is at a low level but rose between 2008 and 2011. Paradoxically the proportion of those diagnosed with malaria who were correctly treated with ACT dropped between 2008 and 2011, as did the proportion of children with fever who were correctly managed. No factors assessed in this study were found to be consistently associated in both 2008 and 2011 with either testing for malaria, or treating confirmed malaria cases with ACT, or managing patients with fever correctly. Recommendations: In order for health workers to correctly implement the "test and treat" policy, which involves a series of complex steps, they ought to be formally trained to do so, mentored and constructively supervised. Additionally health facilities should be adequately equipped to enable health workers to fully implement the policy. Further studies to assess factors associated with the correct management of malaria via the "test and treat" policy are warranted.

Blood is considered one of the most widely tested biological matrices. The first step in blood identification involves visual examination followed by presumptive testing. Once a positive presumptive result is observed, confirmatory tests are performed to determine that a stain is human blood, thus reducing the time and resources spent on forensically irrelevant samples. When interfering agents are present, this general workflow is hindered as presumptive tests can render false-negative results. General awareness of these interfering agents can help analysts to recognize forensically relevant evidence that may have otherwise been deemed immaterial. The main objective of this study was to understand various interfering agents and their effects on presumptive blood tests such as Kastle Meyer (KM) and Orthotolidine (O-tol) reagents and confirmatory tests such as HemaTrace® and Rapid Stain Identification (RSID™) Blood. Additional experiments explored the effects on downstream DNA analysis. In the first part of the study, bloodstains in varying concentrations were exposed to ten chemical interferents over a period of time to understand how blood dilution, age of the stain, and the chemical nature of the interferent affect presumptive blood test results. Antioxidants, active oxygen, and tannins are known to interrupt the mechanism of presumptive tests. Thus, ten interfering agents (ascorbic acid, chlorogenic acid, catechin, sodium percarbonate, hydrogen peroxide, oxalic acid, proanthocyanidins, quebracho extract, chestnut extract, and theaflavin) were selected based on these characteristics. Six blood dilutions (neat, 1:10, 1:50, 1:100, 1:500, and 1:1000) were exposed to the interferents, and presumptive tests for blood were conducted on six days (day 1, 8, 22, 43, 71, and 106). The second part of the study examined bloodstains deposited on real-world samples (wines, citrus fruit juices, teas, coffee, cleaning agents, and leather products) containing chemical interferents. In addition, confirmatory testing for human blood was conducted with HemaTrace® and RSID™-Blood on day 106 using the 1:500 dilution. Finally, DNA analysis of 1:10 dilution stains was performed on day 150 to study whether downstream DNA analysis was compromised due to the presence of the interferents. The results showed that as blood concentration reduced, more false-negative results were observed when chemical interferents were present. Further, chemical interferents produced frequent atypical color changes in tests with KM and O-tol reagents, while only some atypical color changes were observed with the household products tested. Immunochromatographic assay results indicated both HemaTrace® and RSID™-Blood could detect the presence of blood when interfering agents are present, although the positive result bands with RSID™-Blood were faint and sometimes difficult to visualize. Poor DNA results from the untreated blood sample limited any interpretation of the DNA results obtained from bloodstains deposited on household products. Overall, the data indicates that valuable blood evidence may be overlooked due to faint or false-negative results when these interferents are present. Future studies should focus on how these interferents may affect downstream DNA analysis.

No description available.