Risk of cardiovascular events from current, recent, and cumulative exposure to abacavir among persons living with HIV who were receiving antiretroviral therapy in the United States: a cohort study.

BackgroundThere is ongoing controversy regarding abacavir use in the treatment of HIV infection and the risk of subsequent development of cardiovascular disease. It is unclear how the risk varies as exposure accumulates.MethodsUsing an administrative health-plan dataset, risk of cardiovascular disease events (CVDe), defined as the first episode of an acute myocardial infarction or a coronary intervention procedure, associated with abacavir exposure was assessed among HIV-infected individuals receiving antiretroviral therapy across the U.S. from October 2009 through December 2014. The data were longitudinal, and analyzed using marginal structural models.ResultsOver 114,470 person-years (n = 72,733) of ART exposure, 714 CVDe occurred at an incidence rate (IR) (95% CI) of 6·23 (5·80, 6·71)/1000 person-years. Individuals exposed to abacavir had a higher IR of CVDe of 9·74 (8·24, 11·52)/1000 person-years as compared to 5·75 (5·30, 6·24)/1000 person-years for those exposed to other antiretroviral agents. The hazard (HR; 95% CI) of CVDe was increased for current (1·43; 1·18, 1·73), recent (1·41; 1·16, 1·70), and cumulative [(1·18; 1·06, 1·31) per year] exposure to abacavir. The risk for cumulative exposure followed a bell-shaped dose-response curve peaking at 24-months of exposure. Risk was similarly elevated among participants free of pre-existing heart disease or history of illicit substance use at baseline.ConclusionCurrent, recent, and cumulative use of abacavir was associated with an increased risk of CVDe. The findings were consistent irrespective of underlying cardiovascular risk factors

First report of multi-drug resistant tuberculosis in a systemic lupus erythematosus patient.

BackgroundTreatment of a multi-drug resistant tuberculosis (MDR-TB) patient is clinically challenging, requiring a minimum of 18 months of therapy. Its occurrence in a systemic lupus erythromatosus (SLE) patient may complicate management of both MDR-TB and SLE. This is the first descriptive report of MDR-TB in an SLE patient.Case presentationA 19-year old female receiving long-term prednisolone for SLE was diagnosed with MDR-TB. She was started on MDR-TB treatment regimen and prednisolone was replaced with azathioprine. After an initial response to therapy, patient experienced a flare of lupus symptoms. Imaging studies revealed avascular necrosis of right femoral head. She was then treated with intravenous methyl-prednisolone, followed by maintenance corticosteroid. Azathioprine was discontinued due to hematological toxicity and failure to control SLE. Her symptoms of lupus regressed and did not re-occur for the duration of her MDR-TB treatment. Patient was declared cured of MDR-TB after 18 months of ATT. She is currently scheduled for a total hip replacement surgery.ConclusionsThis case highlights the challenges of simultaneously managing MDR-TB and SLE in a patient due to their over-lapping signs and symptoms, drug-drug interactions, and the need for use of immunomodulatory agents in the absence of standard guidelines and documented previous experiences. Our experience underscores the importance of appropriate selection of treatment regimens for both MDR-TB and SLE

Analysis of Swine Movements in a Province in Northern Vietnam and Application in the Design of Surveillance Strategies for Infectious Diseases

While swine production is rapidly growing in South-East Asia, the structure of the swine industry and the dynamic of pig movements have not been well-studied. However, this knowledge is a prerequisite for understanding the dynamic of disease transmission in swine populations and designing cost-effective surveillance strategies for infectious diseases. In this study, we assessed the farming and trading practices in the Vietnamese swine familial farming sector, which accounts for most pigs in Vietnam, and for which disease surveillance is a major challenge. Farmers from two communes of a Red River Delta Province (northern Vietnam) were interviewed, along with traders involved in pig transactions. Major differences in the trade structure were observed between the two communes. One commune had mainly transversal trades, that is between farms of equivalent sizes, whereas the other had pyramidal trades, that is from larger to smaller farms. Companies and large familial farrow-to-finish farms were likely to act as major sources of disease spread through pig sales, demonstrating their importance for disease control. Familial fattening farms with high pig purchases were at greater risk of disease introduction and should be targeted for disease detection as part of a risk-based surveillance. In contrast, many other familial farms were isolated or weakly connected to the swine trade network limiting their relevance for surveillance activities. However, some of these farms used boar hiring for breeding, increasing the risk of disease spread. Most familial farms were slaughtering pigs at the farm or in small local slaughterhouses, making the surveillance at the slaughterhouse inefficient. In terms of spatial distribution of the trades, the results suggested that northern provinces were highly connected and showed some connection with central and southern provinces. These results are useful to develop risk-based surveillance protocols for disease detection in the swine familial sector and to make recommendations for disease control. (Résumé d'auteur

Wege von der nachholenden zur nachhaltigen Entwicklung: Infrastrukturen und deren Transfer im Zeitalter der Globalisierung. Welche Globalisierung ist zukunftsfähig?

Infrastrukturen und Infrastrukturpolitik nehmen einen entscheidenden Einfluss aufdie Nachhaltigkeit eines Landes. Betrachtet man die (Fehl-) Entwicklungen desletzten Jahrhunderts in den Industrieländern, so ist zu erkennen, dass die der-zeitigen Energie-, Verkehrs- und Wasserinfrastrukturen selbst den Anforderungeneiner ökonomischen Nachhaltigkeit nicht gewachsen sind. Ihre sozialen und ökologischen Folgen wurden zudem meist vernachlässigt und spielten bei Entscheidungsprozessen nur eine nachrangige Rolle. Große Herausforderungenliegen vor den Industrieländern, wenn sie nachhaltige Infrastrukturen schaffenwollen - und gar eine Leitbildfunktion für Schwellen- und Entwicklungsländer im 21. Jahrhundert einnehmen möchten. Denn durch die Intensivierung der weltweiten Austauschbeziehungen werden die nicht-nachhaltigen Infrastruktur-konzepte und -politiken der Industrieländer zunehmend auf Entwicklungsländerübertragen. Eine Umorientierung muss deshalb auch im Süden erfolgen.Dieses Wuppertal Paper bietet am Beispiel der drei wichtigen Sektoren Energie,Verkehr und Wasser Ansätze einer nachhaltigen Infrastrukturpolitik. Dazugehören sowohl globale Lösungsstrategien als auch spezifische Instrumente fürdie Länder des Nordens oder des Südens. Im Rahmen von sektoralen Fallstudienwerden die Schwellenländer Brasilien (Energie), China (Verkehr) und Indonesien (Wasser) betrachtet. Zudem werden Strategien und Erfolgsfaktoren für eine anNachhaltigkeitszielen orientierte Transferpolitik skizziert, wobei auch auf dieBedeutung von Bildung und die Rolle internationaler Finanzinstitutionen (am Beispiel der Weltbank) eingegangen wird. Um die großen Herausforderungeneiner globalen nachhaltigen Entwicklung zu bewältigen, schlägt dieses Papier vor,mehrere Strategien parallel zu verfolgen. Im Norden sind die gegenwärtigenressourcenintensiven, nicht-nachhaltigen Infrastrukturen zu überdenken. Im Südensollte der Pfad der nachholenden Entwicklung verlassen und im Sinne einesökologischen leapfrogging der Sprung in post-fossile Infrastrukturen angestrebtwerden, um nicht die Fehler des Nordens zu wiederholen. Länderspezifische Lösungen sollten dabei an die Stelle eines Imports nicht-angepasster Infrastruk-turen treten. Der Transfer und Austausch von Ideen, Konzepten und Lösungenkann dabei einen wesentlichen Beitrag leisten, wobei eine unidirektionale Entwicklungszusammenarbeit von Nord nach Süd nicht ausreicht. Auch Süd-Süd-oder Süd-Nord-Kooperationen eröffnen wichtige Chancen. Zudem ist der industrieländerzentrische, Technologie orientierte Ansatz einer einfachen Optimierungder supply-side zu verlassen zugunsten einer Handlungsstrategie, die ein nachhaltiges demand-side-management integriert. --

The prospect of educational technology in Tibetan schools in India

The purpose of this research paper was to determine the prospect of educational technology in Tibetan schools in India. In order to look at this, an attempt has been made to determine the present status of technology in Tibetan schools by collecting data through survey, telephone interview, electronic mail, on-line resources, and documents published by related organizations. This paper also focuses on the present situation of the Tibetan schools, and looks at the primary problems of technology integration into the schools. Through survey and telephone interview, an attempt was made to determine the attitude and motivation of teachers, administrators, and students to integrate technology into the school infrastructure. Information on computer technology, Internet Service Providers and other relevant materials in India are gathered to help determine the goals and objectives of educational technology

Monitoring and Control of a Variable Frequency Drive Using PLC and SCADA

Programmable Logic Controller (PLC) and Supervisory Control And Data Acquisition (SCADA) are two new approaches to control a Variable Frequency Drive (VFD) whose output is fed to a three-phase induction motor and driving a conveyor belt. The conveyor belt has three sensors are inputs which senses a passing object and carries out the necessary instructions programmed in ladder logic programming of the PLC through the medium of a personal computer (PC). The SCADA software installed in the PC in turn enables the human operator to control the entire operation away from the plant and just by using the virtual inputs designated on his computer screen. The results have been verified with a validating experiment

Fuzzy Logic Control of Three Phase Induction Motor Using Rotor Resistance Control Method

This work is based on an intelligent speed control system with the application of fuzzy logic on a three phase induction motor. Fuzzy logic was applied to traditional method of speed control of three phase induction motor such as Rotor Resistance Control where inputs such as rotor resistance, line voltage and two loads attached to the motor were varied. With the variations in the inputs, it was observed that appropriate variations in outputs such as speed, slip, torque, output power and efficiency were achieved. By using the Mamdani Fuzzy Model, an analysis of rule-based Fuzzy Logic Controller was applied in which the system can be taught to predict the output depending on the variations in the input variables

Can Pollution Bring Balance to the Hidden Land?

Cham, a distinctive masked ritual dance, is undertaken biannually at Pemayangtse Monastery, a Buddhist institution in Sikkim, a Himalayan state in northeast India. These ritual performances are intended to dispel negative forces and create the conditions of prosperity and health for all of the beings – including humans, spirits and deities – resident in Sikkim’s sacred landscape and throughout the cosmos. The efficacy of ritual dances is intertwined with the context of the performances and the materiality of the dancers’ costumes. This article will engage debates over cham’s changing materiality. In particular, it will focus on the recent introduction of fibreglass masks in Pemayangtse’s ritual dances to explore connections between changing ecologies, notions of toxicity and pollution and ritual economies in Sikkim. While Buddhist authorities express anxiety about the substances involved in creating fibreglass, they also appreciate its affordability and durability. Artists who work in fibreglass see the material as a fast way to work. The dancers, on the other hand, express concern about how changes in the physicality of dancing with these masks may interfere with ritual efficacy. These debates are illustrative of broader concerns about the impact of changing ecosystems on interdimensional relations in the Himalayas

One Health research and training and government support for One Health in South Asia

Introduction: Considerable advocacy, funding, training, and technical support have been provided to South Asian countries to strengthen One Health (OH) collaborative approaches for controlling diseases with global human pandemic potential since the early 2000s. It is essential that the OH approach continues to be strengthened given South Asia is a hot spot for emerging and endemic zoonotic diseases. The objectives of this article are to describe OH research and training and capacity building activities and the important developments in government support for OH in these countries to identify current achievements and gaps. Materials and methods: A landscape analysis of OH research, training, and government support in South Asia was generated by searching peer-reviewed and grey literature for OH research publications and reports, a questionnaire survey of people potentially engaged in OH research in South Asia and the authors’ professional networks. Results: Only a small proportion of zoonotic disease research conducted in South Asia can be described as truly OH, with a significant lack of OH policy-relevant research. A small number of multisectoral OH research and OH capacity building programmes were conducted in the region. The governments of Bangladesh and Bhutan have established operational OH strategies, with variable progress institutionalising OH in other countries. Identified gaps were a lack of useful scientific information and of a collaborative culture for formulating and implementing integrated zoonotic disease control policies and the need for ongoing support for transdisciplinary OH research and policy-relevant capacity building programmes. Discussion: Overall we found a very small number of truly OH research and capacity building programmes in South Asia. Even though significant progress has been made in institutionalising OH in some South Asian countries, further behavioural, attitudinal, and institutional changes are required to strengthen OH research and training and implementation of sustainably effective integrated zoonotic disease control policies