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HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities.
Design:
Longitudinal study
Participants:
A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March–May 2016 and followed up March–May 2017.
Measurements:
HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records.
Results:
In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9–53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0–28.6 n = 16) was observed.
Conclusions:
HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.
We assessed whether paternal demographic, anthropometric and clinical factors influence the risk of an infant being born large-for-gestational-age (LGA). We examined the data on 3659 fathers of term offspring (including 662 LGA infants) born to primiparous women from Screening for Pregnancy Endpoints (SCOPE). LGA was defined as birth weight >90th centile as per INTERGROWTH 21st standards, with reference group being infants ⩽90th centile. Associations between paternal factors and likelihood of an LGA infant were examined using univariable and multivariable models. Men who fathered LGA babies were 180 g heavier at birth (P<0.001) and were more likely to have been born macrosomic (P<0.001) than those whose infants were not LGA. Fathers of LGA infants were 2.1 cm taller (P<0.001), 2.8 kg heavier (P<0.001) and had similar body mass index (BMI). In multivariable models, increasing paternal birth weight and height were independently associated with greater odds of having an LGA infant, irrespective of maternal factors. One unit increase in paternal BMI was associated with 2.9% greater odds of having an LGA boy but not girl; however, this association disappeared after adjustment for maternal BMI. There were no associations between paternal demographic factors or clinical history and infant LGA. In conclusion, fathers who were heavier at birth and were taller were more likely to have an LGA infant, but maternal BMI had a dominant influence on LGA.
Research conducted since 1979 in the north central United States and southern Canada demonstrated that after repeated annual applications of the same thiocarbamate herbicide to the same field, control of some difficult-to-control weed species was reduced. Laboratory studies of herbicide degradation in soils from these fields indicated that these performance failures were due to more rapid or “enhanced” biodegradation of the thiocarbamate herbicides after repeated use with a shorter period during which effective herbicide levels remained in the soils. Weeds such as wild proso millet [Panicum miliaceum L. spp. ruderale (Kitagawa) Tzevelev. #3 PANMI] and shattercane [Sorghum bicolor (L.) Moench. # SORVU] which germinate over long time periods were most likely to escape these herbicides after repeated use. Adding dietholate (O,O-diethyl O-phenyl phosphorothioate) to EPTC (S-ethyl dipropyl carbamothioate) reduced problems caused by enhanced EPTC biodegradation in soils treated previously with EPTC alone but not in soils previously treated with EPTC plus dietholate. While previous use of other thiocarbamate herbicides frequently enhanced biodegradation of EPTC or butylate [S-ethyl bis(2-methylpropyl)carbamothioate], previous use of other classes of herbicides or the insecticide carbofuran (2,3 -dihydro-2,2 -dimethyl-7-benzofuranyl methylcarbamate) did not. Enhanced biodegradation of herbicides other than the thiocarbamates was not observed.
Human factors certification criteria are being developed for large civil aircraft with the objective of reducing the incidence of design-induced error on the flight deck. Many formal error identification techniques currently exist which have been developed in non-aviation contexts but none have been validated for use to this end. This paper describes a new human error identification technique (HET – human error template) designed specifically as a diagnostic tool for the identification of design-induced error on the flight deck. HET is benchmarked against three existing techniques (SHERPA – systematic human error reduction and prediction approach; human error HAZOP – hazard and operability study; and HEIST – human error In systems tool). HET outperforms all three existing techniques in a validation study comparing predicted errors to actual errors reported during an approach and landing task in a modern, highly automated commercial aircraft. It is concluded that HET should provide a useful tool as a adjunct to the proposed human factors certification process.
Cannabis use is associated with an earlier age at onset of psychotic illness. The aim of the present study was to examine whether this association is confounded by gender or other substance use in a large cohort of patients with a non-affective psychotic disorder.
Method
In 785 patients with a non-affective psychotic disorder, regression analysis was used to investigate the independent effects of gender, cannabis use and other drug use on age at onset of first psychosis.
Results
Age at onset was 1.8 years earlier in cannabis users compared to non-users, controlling for gender and other possible confounders. Use of other drugs did not have an additional effect on age at onset when cannabis use was taken into account. In 63.5% of cannabis-using patients, age at most intense cannabis use preceded the age at onset of first psychosis. In males, the mean age at onset was 1.3 years lower than in females, controlling for cannabis use and other confounders.
Conclusions
Cannabis use and gender are independently associated with an earlier onset of psychotic illness. Our findings also suggest that cannabis use may precipitate psychosis. More research is needed to clarify the neurobiological factors that make people vulnerable to this precipitating effect of cannabis.
Megapodes: an action plan for their conservation 1995–1999) was published in 1995 by the Species Survival Commission of IUCN – The World Conservation Union. It is the twenty-eighth publication in its Action Plan series and the first for any group of birds. Action Plans published under the auspices of the Species Survival Commission are perceived as a means of making information on the status, threats and action required to safeguard species available to conservation planners and others in a position to take action. They are compiled by the appropriate taxon Specialist Group of the Species Survival Commission and their production and implementation is central to the Commission's activities. As well as the megapodes, Action Plans have recently been compiled for the partridges, quails, francolins, snowcocks and guineafowl, and for the pheasants. Stimulating interest in the conservation of these three groups of birds is the responsibility of three Specialist Groups which operate under the joint parentage of the World Pheasant Association, BirdLife International and the Species Survival Commission. The World Pheasant Association is the umbrella organization for five Galliformes Specialist Groups and was the driving force behind the production of these Action Plans, providing the means for the Specialist Groups to compile the information. This paper outlines the scope of these Action Plans and explains how they were compiled in the hope that this may assist the production of Action Plans for other bird groups.
In this paper, we discuss the grounding of the Royal Majesty, reconstructed from the perspective of the crew. The aim is particularly to understand the role of automation in shaping crew assessments and actions. Automation is often introduced because of quantitative promises that: it will reduce human error; reduce workload; and increase efficiency. But as demonstrated by the Royal Majesty, as well as by numerous research results, automation has qualitative consequences for human work and safety, and does not simply replace human work with machine work. Automation changes the task it was meant to support; it creates new error pathways, shifts consequences of error further into the future and delays opportunities for error detection and recovery. By going through the sequence of events that preceded the grounding of the Royal Majesty, we highlight the role that automation plays in the success and failure of navigation today. We then point to future directions on how to make automated systems into better team players.
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