HIV-Associated TB in An Giang Province, Vietnam, 2001–2004: Epidemiology and TB Treatment Outcomes

BACKGROUND: Mortality is high in HIV-infected TB patients, but few studies from Southeast Asia have documented the benefits of interventions, such as co-trimoxazole (CTX), in reducing mortality during TB treatment. To help guide policy in Vietnam, we studied the epidemiology of HIV-associated TB in one province and examined factors associated with outcomes, including the impact of CTX use. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively abstracted data for all HIV-infected persons diagnosed with TB from 2001-2004 in An Giang, a province in southern Vietnam in which TB patients receive HIV counseling and testing. We used standard WHO definitions to classify TB treatment outcomes. We conducted multivariate analysis to identify risk factors for the composite outcome of death, default, or treatment failure during TB treatment. From 2001-2004, 637 HIV-infected TB patients were diagnosed in An Giang. Of these, 501 (79%) were male, 321 (50%) were aged 25-34 years, and the most common self-reported HIV risk factor was sex with a commercial sex worker in 221 (35%). TB was classified as smear-positive in 531 (83%). During TB treatment, 167 (26%) patients died, 9 (1%) defaulted, and 6 (1%) failed treatment. Of 454 patients who took CTX, 116 (26%) had an unsuccessful outcome compared with 33 (70%) of 47 patients who did not take CTX (relative risk, 0.4; 95% confidence interval [CI], 0.3-0.5). Adjusting for male sex, rural residence, TB smear status and disease location, and the occurrence of adverse events during TB treatment in multivariate analysis, the benefit of CTX persisted (adjusted odds ratio for unsuccessful outcome 0.1; CI, 0.1-0.3). CONCLUSIONS/SIGNIFICANCE: In An Giang, Vietnam, HIV-associated TB was associated with poor TB treatment outcomes. Outcomes were significantly better in those taking CTX. This finding suggests that Vietnam should consider applying WHO recommendations to prescribe CTX to all HIV-infected TB patients

Design and Evaluation of a New Boundary-Layer Rake for Flight Testing

A new boundary-layer rake has been designed and built for flight testing on the NASA Dryden Flight Research Center F-15B/Flight Test Fixture. A feature unique to this rake is its curved body, which allows pitot tubes to be more densely clustered in the near-wall region than conventional rakes allow. This curved rake design has a complex three-dimensional shape that requires innovative solid-modeling and machining techniques. Finite-element stress analysis of the new design shows high factors of safety. The rake has passed a ground test in which random vibration measuring 12 g rms was applied for 20 min in each of the three normal directions. Aerodynamic evaluation of the rake has been conducted in the NASA Glenn Research Center 8 x 6 Supersonic Wind Tunnel at Mach 0-2. The pitot pressures from the new rake agree with conventional rake data over the range of Mach numbers tested. The boundary-layer profiles computed from the rake data have been shown to have the standard logarithmic-law profile. Skin friction values computed from the rake data using the Clauser plot method agree with the Preston tube results and the van Driest II compressible skin friction correlation to approximately +/-5 percent

In-Flight Capability for Evaluating Skin-Friction Gages and Other Near-Wall Flow Sensors

An 8-in.-square boundary-layer sensor panel has been developed for in-flight evaluation of skin-friction gages and other near-wall flow sensors on the NASA Dryden Flight Research Center F-15B/Flight Test Fixture (FTF). Instrumentation on the sensor panel includes a boundary-layer rake, temperature sensors, static pressure taps, and a Preston tube. Space is also available for skin-friction gages or other near-wall flow sensors. Pretest analysis of previous F-15B/FTF flight data has identified flight conditions suitable for evaluating skin-friction gages. At subsonic Mach numbers, the boundary layer over the sensor panel closely approximates the two-dimensional (2D), law-of-the-wall turbulent boundary layer, and skin-friction estimates from the Preston tube and the rake (using the Clauser plot method) can be used to evaluate skin-friction gages. At supersonic Mach numbers, the boundary layer over the sensor panel becomes complex, and other means of measuring skin friction are needed to evaluate the accuracy of new skin-friction gages. Results from the flight test of a new rubber-damped skin-friction gage confirm that at subsonic Mach numbers, nearly 2D, law-of-the-wall turbulent boundary layers exist over the sensor panel. Sensor panel data also show that this new skin-friction gage prototype does not work in flight

Crystal Structure and Mutational Analysis of the DaaE Adhesin of Escherichia coli *

DaaE is a member of the Dr adhesin family of Escherichia coli, members of which are associated with diarrhea and urinary tract infections. A receptor for Dr adhesins is the cell surface protein, decay-accelerating factor (DAF). We have carried out a functional analysis of Dr adhesins, as well as mutagenesis and crystallographic studies of DaaE, to obtain detailed molecular information about interactions of Dr adhesins with their receptors. The crystal structure of DaaE has been solved at 1.48 A ˚ resolution. Trimers of the protein are found in the crystal, as has been the case for other Dr adhesins. Naturally occurring variants and directed mutations in DaaE have been generated and analyzed for their ability to bind DAF. Mapping of the mutation sites onto the DaaE molecular structure shows that several of them contribute to a contiguous surface that is likely the primary DAFbinding site. The DAF-binding properties of purified fimbria

Detection of Shigella by a PCR Assay Targeting the ipaH Gene Suggests Increased Prevalence of Shigellosis in Nha Trang, Vietnam

Shigella spp. are exquisitely fastidious gram-negative organisms which frequently escape detection by traditional culture methods. To get a more complete understanding of the disease burden caused by Shigella in Nha Trang, Vietnam, real-time PCR was used to detect Shigella DNA. Randomly selected rectal swab specimens from 60 Shigella culture-positive patients and 500 Shigella culture-negative patients detected by population-based surveillance of patients seeking care for diarrhea were processed by real-time PCR. The target of the primer pair is the invasion plasmid antigen H gene sequence (ipaH), carried by all four Shigella species and enteroinvasive Escherichia coli. Shigella spp. could be isolated from the rectal swabs of 547 of 19,206 (3%) patients with diarrhea. IpaH was detected in 55 of 60 (93%) Shigella culture-positive specimens, whereas it was detected in 87 of 245 (36%) culture-negative patients free of dysentery (P < 0.001). The number of PCR cycles required to detect a PCR product was highest for culture-negative, nonbloody diarrheal specimens (mean number of cycles to detection, 36.6) and was lowest for children with culture-positive, bloody diarrheal specimens (mean number of cycles, 25.3) (P < 0.001). The data from real-time PCR amplification indicate that the culture-proven prevalence of Shigella among patients with diarrhea may underestimate the prevalence of Shigella infections. The clinical presentation of shigellosis may be directly related to the bacterial load

Two decades of French urban policy: from social development of neighbourhoods to the republican penal state

This paper provides an overview of French national urban policy for the period 1981-2002, organized around three themes: spatial conceptualizations of intervention areas and changing scales of intervention, discursive articulations of intervention areas, and legitimation of state intervention. By relating the transformations of this policy to the contemporary restructuring of the French state, the paper argues that although there are elements of convergence, the contemporary restructuring of the French state differs remarkably from a US or UK-style neoliberalization, partly because of the republican tradition emphasizing the active role of the state for the well-being of its citizens. This restructuring carries the signs of the strong state tradition in France, and is best understood as an articulation of neoliberalism with established political traditions, an articulation that I try to capture with the notion of a "republican penal state"