224 research outputs found
In utero exposure to antiretroviral therapy: feasibility of long-term follow-up.
No full textMost uninfected children born to diagnosed HIV-infected women in the United Kingdom (UK) are exposed to antiretroviral therapy (ART) in utero and neonatally, and concerns exist about potential adverse effects of such exposure. We explored the feasibility of using national clinic-based follow-up to investigate the association between ART exposure and adverse health events occurring after the neonatal period. Active surveillance of obstetric and paediatric HIV infection is conducted through the National Study of HIV in Pregnancy and Childhood (NSHPC). Between 2002 and 2005, health professionals enrolled previously notified uninfected children in a consented follow-up study (the CHildren exposed to AntiRetroviral Therapy (CHART) study). Follow-up information was collected opportunistically using a standard questionnaire. Of 2104 eligible uninfected children born in the UK between 1996 and 2004, 704 (33.5%) were enrolled in CHART; parents of 4.8% (100/2104) declined, 2.8% (59/2104) had gone abroad, 21.6% (455/2104) were not contactable, and the remaining 37.3% (786/2104) were not enrolled mainly because of lack of clinic resources or unwillingness of health professionals to approach the families. Demographic characteristics and type of ART exposure for enrolled and non-enrolled children were similar. Latest information on enrolled children was available at a median age of 24 months. Minor childhood ailments were reported in the majority of children, febrile seizures in 1.6% (11/704), and major health problems in 3.8% (27/704). It was reassuring that prevalence of these outcomes was within UK norms, but numbers were small and duration of follow-up was limited. The difficulties encountered in enrolling and retaining children in this study indicate that comprehensive clinic-based follow-up of ART-exposed uninfected children is not practical. Alternative approaches are required; a robust, secure data linkage protocol would provide a more feasible and sustainable system for long-term monitoring of in utero ART exposure
Alternate Title: Let Me Call You Sweetheart I'm in Love With You
No full textFirst Line: I am dreaming dear of you day by day dreaming when the skies are blueFirst Line of Chorus: Let me call you "sweetheart" I'm in love with you let me hear you whisper that you love me tooKey: B Flat Majo
Re-placing Malcolm Lowry: From the Mersey to the world (and back again)
No full textThis article focuses on a group project that the author has been involved with since its inception in 2009, centring on the Merseyside-born writer Malcolm Lowry (1909–1957). The article outlines the background to the project, how it developed, what it has involved and the ways in which it sits within the context of an arts centre and a university. It focuses on the importance of place, both in relation to the project’s aims and in relation to Lowry’s own writing. The overall aim of the project can be stated in terms of ‘re-placing’ Lowry: raising his profile on Merseyside (and more widely) as a writer for whom Merseyside remained a significant imaginative resource, making his life and works accessible to new audiences/readerships through a wide range of activities, and establishing Merseyside as a centre for an ongoing programme of work, ideas and events related to Lowry
Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland
No full textObjective To describe changes in demographic factors, disease progression, hospital admissions, and use of antiretroviral therapy in children with HIV.
Design Active surveillance through the national study of HIV in pregnancy and childhood (NSHPC) and additional data from a subset of children in the collaborative HIV paediatric study (CHIPS).
Setting United Kingdom and Ireland.
Participants 944 children with perinatally acquired HIV-1 under clinical care.
Main outcome measures Changes over time in progression to AIDS and death, hospital admission rates, and use of antiretroviral therapy.
Results 944 children with perinatally acquired HIV were reported in the United Kingdom and Ireland by October 2002; 628 (67%) were black African, 205 (22%) were aged >= 10 years at last follow up, 193 (20%) are known to have died. The proportion of children presenting who were born abroad increased from 20% in 1994-5 to 60% during 2000-2. Mortality was stable before 1997 at 9.3 per 100 child years at risk but fell to 2.0 in 2001-2 (trend P < 0.001). Progression to AIDS also declined (P < 0.001). From 1997 onwards the proportion of children on three or four drug antiretroviral therapy increased. Hospital admission rates declined by 80%, but with more children in follow up the absolute number of admissions fell by only 26%.
Conclusion In children with HIV infection, mortality, AIDS, and hospital admission rates have declined substantially since the introduction of three or four drug antiretroviral therapy in 1997. As infected children in the United Kingdom and Ireland are living longer, there is an increasing need to address their medical, social, and psychological needs as they enter adolescence and adult life.
Related Article
Evaluating the Economics of Construction and Demolition Waste Minimisation and Zero Waste in the New Zealand Construction Industry
No full textCurrently, up to 50% of construction and demolition (C&D) waste is disposed of in landfills contributing to significant environmental, social and economic costs to New Zealand. However, current understanding of C&D costs is poor both internationally and within New Zealand. This thesis addresses this deficit by developing a framework to evaluate the economics of C&D waste minimisation. An understanding gained from this research could help New Zealand develop appropriate strategies to address C&D waste issues.
As the research problem is complex and wide-ranging, this study used a mixed-method approach. Semi-structured elite interviews with highly experienced construction personnel were used to identify factors affecting a C&D waste minimisation strategy. This also established the context of the economic evaluation framework. Economic modelling was subsequently employed to develop the economic evaluation framework. The framework was then applied on two case studies: 1) a development of a large education facility and 2) a refurbishment of a commercial office space.
The study found that:
1. a C&D waste landfill/cleanfill charge of $150 per tonne can a) deter construction from disposing of waste; and b) force construction to rethink waste disposal
2. C&D waste minimisation can offer clients benefits including tangible returns (i.e. cost savings) and intangible potentials (i.e. increased reputation)
3. there are costs of implementing C&D waste minimisation - but benefits gained can outweigh such costs; and
4. the optimal rate of reduction for C&D waste in the non-residential projects studied was 71% - 78%
Overall, this research has made a contribution to knowledge through the development of a robust economic evaluation framework. Moreover, the study has also provided an impetus for future work in C&D waste minimisation economics in New Zealand
Surveillance of congenital cytomegalovirus in the UK and Ireland
No full textObjective To explore the presentation and management of congenital cytomegalovirus (CMV) identified through routine clinical investigations, and ascertain outcome in early childhood.Design Active population-based surveillance.Setting UK and Ireland.Methods Infants born in 2001-2002 with confirmed or suspected congenital CMV infection were reported through the British Paediatric Surveillance Unit, and clinicians completed questionnaires on presentation, diagnosis, management and subsequent outcome.Results 86 confirmed and 70 possible cases of congenital CMV infection were reported. Over a third (27/72) of singleton infants with confirmed and 44% (27/61) with possible congenital infection were preterm (<37 weeks gestation). Among confirmed cases, 75% (64/85) presented with neonatal manifestations compatible with congenital CMV, over half (34/64) of whom had neurological signs; 17 infants were treated with gancyclovir. Among confirmed cases with information on outcome, 31% (24/78) were developing normally, 18% (14/78) had mild, 24% (19/78) moderate and 14% (11/78) severe sequelae, and 13% (10/78) had died. Median age at follow-up among survivors was 18 months (IQR 15-22 months). Children with neonatal CMV manifestations were significantly more likely than those without to have moderate or severe outcomes (including death) (60%, 36/60, vs 22%, 4/18, p=0.001). 27% of survivors (17/63) had bilateral hearing loss.Conclusions The number of confirmed cases of diagnosed congenital CMV reported in this study was lower than expected, highlighting the need for early and appropriate investigations when congenital infection is suspected. Due to the unexpectedly high proportion of preterm infants, resulting from differential case ascertainment, it was difficult to distinguish prematurity and CMV-related symptoms
The perceptions of retentions as held by clients, contractors and subcontractors
No full textThe payment mechanism of construction projects is different compared to other industries. For every payment made to a contractor or subcontractor a sum of money is held back. This deduction is a phenomenon peculiar to the construction industry and is known as retention. Retentions are held by both clients and contractors and as such involve the whole supply chain. However the effect the practice has on each party varies significantly as a result of which there have been debates regarding the practice. The purpose of this paper is to study the effects of retentions on clients, contractors and subcontractors. The author has conducted an extensive literature review to find out the issues around the practice of retentions and how it affects the parties involved. The impact of the practice on contractors, subcontractors and clients have been studied and analysed. The study is a part of a bigger research conducted which aims to investigate the practice of retentions in the NZ construction industry. It has been concluded that there seems to be an imbalance of power with regards to the retention practice and it is about time that some alternatives be put into place to make the practice fair for all parties
The perceptions of retentions as held by clients, contractors and subcontractors
No full textThe payment mechanism of construction projects is different compared to other industries. For every payment made to a contractor or subcontractor a sum of money is held back. This deduction is a phenomenon peculiar to the construction industry and is known as retention. Retentions are held by both clients and contractors and as such involve the whole supply chain. However the effect the practice has on each party varies significantly as a result of which there have been debates regarding the practice. The purpose of this paper is to study the effects of retentions on clients, contractors and subcontractors. The author has conducted an extensive literature review to find out the issues around the practice of retentions and how it affects the parties involved. The impact of the practice on contractors, subcontractors and clients have been studied and analysed. The study is a part of a bigger research conducted which aims to investigate the practice of retentions in the NZ construction industry. It has been concluded that there seems to be an imbalance of power with regards to the retention practice and it is about time that some alternatives be put into place to make the practice fair for all parties
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