Integrating tuberculosis and HIV care in the primary care setting in South Africa.

BACKGROUND: In many countries including South Africa, the increasing human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have impacted significantly on already weakened public health services. This paper reviews the scope, process and performance of the HIV and TB services in a primary care setting where antiretroviral therapy is provided, in Khayelitsha, South Africa, in order to assess whether there is a need for some form of integration. METHODS: The scope and process of both services were assessed through observations of the service and individual and group interviews with key persons. The performance was assessed by examining the 2001-2002 reports from the health information system and clinical data. RESULTS: The TB service is programme oriented to the attainment of an 85% cure rate amongst smear-positive patients while the HIV service has a more holistic approach to the patient with HIV. The TB service is part of a well-established programme that is highly standardized. The HIV service is in the pilot phase. There is a heavy load at both services and there is large degree of cross-referral between the two services. There are lessons that can be learnt from each service. There is an overlap of activities, duplication of services and under-utilization of staff. There are missed opportunities for TB and HIV prevention, diagnosis and management. CONCLUSIONS: The study suggests that there may be benefits to integrating HIV and TB services. Constraints to this process are discussed

Spectral/hp element methods: recent developments, applications, and perspectives

The spectral/hp element method combines the geometric flexibility of the classical h-type finite element technique with the desirable numerical properties of spectral methods, employing high-degree piecewise polynomial basis functions on coarse finite element-type meshes. The spatial approximation is based upon orthogonal polynomials, such as Legendre or Chebychev polynomials, modified to accommodate C0-continuous expansions. Computationally and theoretically, by increasing the polynomial order p, high-precision solutions and fast convergence can be obtained and, in particular, under certain regularity assumptions an exponential reduction in approximation error between numerical and exact solutions can be achieved. This method has now been applied in many simulation studies of both fundamental and practical engineering flows. This paper briefly describes the formulation of the spectral/hp element method and provides an overview of its application to computational fluid dynamics. In particular, it focuses on the use the spectral/hp element method in transitional flows and ocean engineering. Finally, some of the major challenges to be overcome in order to use the spectral/hp element method in more complex science and engineering applications are discussed

Nanometer-scale sharpness in corner-overgrown heterostructures

A corner-overgrown GaAs/AlGaAs heterostructure is investigated with transmission and scanning transmission electron microscopy, demonstrating self-limiting growth of an extremely sharp corner profile of 3.5 nm width. In the AlGaAs layers we observe self-ordered diagonal stripes, precipitating exactly at the corner, which are regions of increased Al content measured by an XEDS analysis. A quantitative model for self-limited growth is adapted to the present case of faceted MBE growth, and the corner sharpness is discussed in relation to quantum confined structures. We note that MBE corner overgrowth maintains nm-sharpness even after microns of growth, allowing the realization of corner-shaped nanostructures.Comment: 4 pages, 3 figure

LR characterization of chirotopes of finite planar families of pairwise disjoint convex bodies

We extend the classical LR characterization of chirotopes of finite planar families of points to chirotopes of finite planar families of pairwise disjoint convex bodies: a map \c{hi} on the set of 3-subsets of a finite set I is a chirotope of finite planar families of pairwise disjoint convex bodies if and only if for every 3-, 4-, and 5-subset J of I the restriction of \c{hi} to the set of 3-subsets of J is a chirotope of finite planar families of pairwise disjoint convex bodies. Our main tool is the polarity map, i.e., the map that assigns to a convex body the set of lines missing its interior, from which we derive the key notion of arrangements of double pseudolines, introduced for the first time in this paper.Comment: 100 pages, 73 figures; accepted manuscript versio

Racial Differences in Tuberculosis Infection in United States Communities: The Coronary Artery Risk Development in Young Adults Study

Previously reported associations between race/ethnicity and tuberculosis infection have lacked sufficient adjustment for socioeconomic factors. We analyzed race/ethnicity and self-reported tuberculosis infection data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a well-characterized cohort of 5115 black and white participants, and found that after adjusting for sociodemographic and clinical factors, black participants were more likely to report tuberculosis infection and/or disease (odds ratio, 2.0; 95% confidence interval, 1.5–2.9)

Global investments and regional development trajectories: the missing links

Global investments and regional development trajectories: the missing links. Regional Studies. Regional economic development has been long conceptualized as a non-linear, interactive and socially embedded process: these features were traditionally regarded as spatially mediated and highly localized. However, unprecedentedly fast technological change coupled with the intensification of global economic integration has spurred the need to place regional development in a truly open and interdependent framework. Despite substantial progress in the academic literature, rethinking regional development in this perspective still presents a number of challenges in terms of concepts, empirical evidence and policy approaches. Following an interdisciplinary assessment of how openness and connectivity – proxied by one of the many cross-border flows, i.e., global investments – interact with regional economic development trajectories, this paper presents a picture of the geography of foreign investments from and to the European regions and its change after the financial and economic crisis in 2008. This simple exercise sheds some initial light on how the operationalization of regional connectivity can improve one’s empirical understanding of the evolution of regional economies and the policy approach needed to support their reaction to change

A Multi-telescope Campaign on FRB 121102: Implications for the FRB Population

We present results of the coordinated observing campaign that made the first subarcsecond localization of a Fast Radio Burst, FRB 121102. During this campaign, we made the first simultaneous detection of an FRB burst by multiple telescopes: the VLA at 3 GHz and the Arecibo Observatory at 1.4 GHz. Of the nine bursts detected by the Very Large Array at 3 GHz, four had simultaneous observing coverage at other observatories. We use multi-observatory constraints and modeling of bursts seen only at 3 GHz to confirm earlier results showing that burst spectra are not well modeled by a power law. We find that burst spectra are characterized by a ~500 MHz envelope and apparent radio energy as high as $10^{40}$ erg. We measure significant changes in the apparent dispersion between bursts that can be attributed to frequency-dependent profiles or some other intrinsic burst structure that adds a systematic error to the estimate of DM by up to 1%. We use FRB 121102 as a prototype of the FRB class to estimate a volumetric birth rate of FRB sources $R_{FRB} \approx 5x10^{-5}/N_r$ Mpc$^{-3}$ yr$^{-1}$, where $N_r$ is the number of bursts per source over its lifetime. This rate is broadly consistent with models of FRBs from young pulsars or magnetars born in superluminous supernovae or long gamma-ray bursts, if the typical FRB repeats on the order of thousands of times during its lifetime.Comment: 17 pages, 7 figures. Submitted to AAS Journal

iPTF16fnl: a faint and fast tidal disruption event in an E+A galaxy

We present ground-based and \textit{Swift} observations of iPTF16fnl, a likely tidal disruption event (TDE) discovered by the intermediate Palomar Transient Factory (iPTF) survey at 66.6 Mpc. The lightcurve of the object peaked at absolute $M_g=-17.2$ mag. The maximum bolometric luminosity (from optical and UV) was $L_p~\simeq~(1.0\,\pm\,0.15) \times 10^{43}$ erg/s, an order of magnitude fainter than any other optical TDE discovered so far. The luminosity in the first 60 days is consistent with an exponential decay, with $L \propto e^{-(t-t_0)/\tau}$, where $t_0$=~57631.0 (MJD) and $\tau\simeq 15$ days. The X-ray shows a marginal detection at $L_X=2.4^{1.9}_{-1.1}\times 10^{39}$ erg/s (\textit{Swift} X-ray Telescope). No radio counterpart was detected down to 3$\sigma$, providing upper limits for monochromatic radio luminosity of $\nu L_{\nu} < 2.3\times10^{36}$ erg/s and $\nu L_{\nu}<1.7\times 10^{37}$ erg/s (VLA, 6.1 and 22 GHz). The blackbody temperature, obtained from combined \textit{Swift} UV and optical photometry, shows a constant value of 19,000 K. The transient spectrum at peak is characterized by broad He II and H$\alpha$ emission lines, with an FWHM of about 14,000 km/s and 10,000 km/s respectively. He I lines are also detected at $\lambda\lambda$ 5875 and 6678. The spectrum of the host is dominated by strong Balmer absorption lines, which are consistent with a post-starburst (E+A) galaxy with an age of $\sim$650 Myr and solar metallicity. The characteristics of iPTF16fnl make it an outlier on both luminosity and decay timescales, as compared to other optically selected TDEs. The discovery of such a faint optical event suggests a higher rate of tidal disruptions, as low luminosity events may have gone unnoticed in previous searches.Comment: 14 pages, 11 figures, accepted for publication in Ap

Scaling the Non-linear Impact Response of Flat and Curved Composite Panels

The application of scaling laws to thin flat and curved composite panels exhibiting nonlinear response when subjected to low-velocity transverse impact is investigated. Previous research has shown that the elastic impact response of structural configurations exhibiting geometrically linear response can be effectively scaled. In the present paper, a preliminary experimental study is presented to assess the applicability of the scaling laws to structural configurations exhibiting geometrically nonlinear deformations. The effect of damage on the scalability of the structural response characteristics, and the effect of scale on damage development are also investigated. Damage is evaluated using conventional methods including C-scan, specimen de-plying and visual inspection of the impacted panels. Coefficient of restitution and normalized contact duration are also used to assess the extent of damage. The results confirm the validity of the scaling parameters for elastic impacts. However, for the panels considered in the study, the extent and manifestation of damage do not scale according to the scaling laws. Furthermore, the results indicate that even though the damage does not scale, the overall panel response characteristics, as indicated by contact force profiles, do scale for some levels of damage