Population Differences in Death Rates in HIV-Positive Patients with Tuberculosis.

SETTING: Randomised controlled clinical trial of Mycobacterium vaccae vaccination as an adjunct to anti-tuberculosis treatment in human immunodeficiency virus (HIV) positive patients with smear-positive tuberculosis (TB) in Lusaka, Zambia, and Karonga, Malawi. OBJECTIVE: To explain the difference in mortality between the two trial sites and to identify risk factors for death among HIV-positive patients with TB. DESIGN: Information on demographic, clinical, laboratory and radiographic characteristics was collected. Patients in Lusaka (667) and in Karonga (84) were followed up for an average of 1.56 years. Cox proportional hazard analyses were used to assess differences in survival between the two sites and to determine risk factors associated with mortality during and after anti-tuberculosis treatment. RESULTS: The case fatality rate was 14.7% in Lusaka and 21.4% in Karonga. The hazard ratio for death comparing Karonga to Lusaka was 1.47 (95% confidence interval [CI] 0.9-2.4) during treatment and 1.76 (95%CI 1.0-3.0) after treatment. This difference could be almost entirely explained by age and more advanced HIV disease among patients in Karonga. CONCLUSION: It is important to understand the reasons for population differences in mortality among patients with TB and HIV and to maximise efforts to reduce mortality

Generalized Geologic Map for Land-Use Planning: Hopkins County, Kentucky

This map is not intended to be used for selecting individual sites. Its purpose is to inform land-use planners, government officials, and the public in a general way about geologic bedrock conditions that affect the selection of sites for various purposes. The properties of thick soils may supercede those of the underlying bedrock and should be considered on a site-to-site basis. At any site, it is important to understand the characteristics of both the soils and the underlying rock

Changes in Mycobacterium tuberculosis Genotype Families Over 20 Years in a Population-Based Study in Northern Malawi

BACKGROUND: Despite increasing interest in possible differences in virulence and transmissibility between different genotypes of M. tuberculosis, very little is known about how genotypes within a population change over decades, or about relationships to HIV infection. METHODS AND PRINCIPAL FINDINGS: In a population-based study in rural Malawi we have examined smears and cultures from tuberculosis patients over a 20-year period using spoligotyping. Isolates were grouped into spoligotype families and lineages following previously published criteria. Time trends, HIV status, drug resistance and outcome were examined by spoligotype family and lineage. In addition, transmissibility was examined among pairs of cases with known epidemiological contact by assessing the proportion of transmissions confirmed for each lineage, on the basis of IS6110 RFLP similarity of the M tuberculosis strains. 760 spoligotypes were obtained from smears from 518 patients from 1986-2002, and 377 spoligotypes from cultures from 347 patients from 2005-2008. There was good consistency in patients with multiple specimens. Among 781 patients with first episode tuberculosis, the majority (76%) had Lineage 4 ("European/American") strains; 9% had Lineage 3 ("East-African/Indian"); 8% Lineage 1 ("Indo-Oceanic"); and 2% Lineage 2 ("East-Asian"); others unclassifiable. Over time the proportion of Lineage 4 decreased from >90% to 60%, with an increase in the other 3 lineages (p<0.001). Lineage 1 strains were more common in those with HIV infection, even after adjusting for age, sex and year. There were no associations with drug resistance or outcome, and no differences by lineage in the proportion of pairs in which transmission was confirmed. CONCLUSIONS: This is the first study to describe long term trends in the four M. tuberculosis lineages in a population. Lineage 4 has probably been longstanding in this population, with relatively recent introductions and spread of Lineages1-3, perhaps influenced by the HIV epidemic

Reef Coral Reproduction in the Eastern Pacific: Costa Rica, Panamá, and the Galápagos Islands (Ecuador). VI. Agariciidae, Pavona clavus

The reproductive ecology of the zooxanthellate reef coral Pavona clavus was investigated at several sites in Costa Rica, Panama, and the Galapagos Islands (Ecuador) over the period 1985–2009. Pavona clavus displayed stable gonochorism as only five hermaphrodites were found in 590 samples. At four of five locations, sex ratios were skewed toward female dominance; however, at Saboga Island (Panama) male colonies predominated. In Panama, sexual maturity was observed in an estimated eight year old female colony, and several colonies of 10–20 years of age demonstrated gametogenesis. Sexual activity was observed at all study sites, but gamete development occurred in only 14–31% of colonies sampled sporadically. Seasonality of gametogenic activity occurred predominantly during the warm/wet season, June to August, at mainland sites (Cano Island, Costa Rica, and Gulfs of Chiriqui and Panama, Panama). This pattern was repeated in the Galapagos Islands, but mainly from March to May when seasonally high sea temperatures and rainfall prevailed there. Histological sampling and field observations indicated that spawning was centered around the full moon, most frequently on lunar day 17, and near sunset (1,800 h). Mean fecundity (mature ova cm-2 live tissue) estimates were significantly different for two sites and ranged from ~1,780 (Saboga Island, Gulf of Panama, seasonally upwelling) to ~4,280 (Uva Is, Gulf of Chiriqui, nonupwelling). Assuming three annual spawning events colony-1 (August, September, October), extrapolation of minimum and maximum fecundities yield 5,340 and 12,840 ova cm-2 year-1. Seasonal, lunar, and diel spawning patterns in nine zooxanthellate species at Uva Island indicate asynchronous coral community spawning

Reproductive Ecology of the Azooxanthellate Coral Tubastraea coccinea in the Equatorial Eastern Pacific: Part V. Dendrophylliidae

The reproductive ecology of Tubastraea coccinea Lesson, an azooxanthellate tropical scleractinian coral, was studied over various periods from 1985 to 2006 at four principal eastern Pacific locations in Costa Rica, Panamá, and the Galápagos Islands (Ecuador). This small (polyp diameter 0.8–1.0 cm), relatively cryptic species produced ova and planulae year round, including colonies with as few as 2–10 polyps. Of 424 colonies examined histologically, 13.7% contained both ova and sperm. Mature ova varied in diameter from ~300 to 800 µm and the time from spawning and fertilization of oocytes to release of brooded planulae was about 6 weeks. Planulae were 0.5–1.5 mm long and they settled and metamorphosed on a variety of substrates after 1–3 days. Spermaries, though more difficult to distinguish in histological sections, were present throughout the year. Spent spermaries were never observed in sections, but several colonies in Panamá and the Galápagos Islands released sperm from night one to night five after full moon, indicating the potential for cross-fertilization among colonies. Planula release was observed at Uva Island (Panamá) in March, May, June, and July, and in general planula presence was higher at warm ocean temperatures at all sites, whether or not the sites were inXuenced by seasonal upwelling. Annual fecundity estimates for T. coccinea are comparable with other high fecundity brooding species, including the zooxanthellate Porites panamensis, with which it co-occurs in Panamá. Tubastraea coccinea is widely distributed in the tropical Indo-Pacific and has colonized substrates in the western Atlantic. In addition to the reproductive characteristics described in the present study, other features of the biology of T. coccinea, such as an ability to withstand conditions that produce bleaching and mortality in zooxanthellate species, may account for its widespread, low-latitude distribution in multiple oceans