Impact of introducing human immunodeficiency virus testing, treatment and care in a tuberculosis clinic in rural Kenya

SETTING: In July 2005, Médecins Sans Frontières and the Ministry of Health, Kenya, implemented an integrated tuberculosis-human immunodeficiency virus (TB-HIV) programme in western Kenya. OBJECTIVE: To evaluate the impact of an integrated TB-HIV programme on patient care and TB programme outcomes. DESIGN: Retrospective evaluation of three time periods: before (January-June 2005), shortly after (January-June 2006) and medium term after (January-December 2007) the implementation of the integrated programme. RESULTS: Respectively 79% and 91% of TB patients were HIV tested shortly and at medium term after service integration. The HIV-positive rate varied from 96% before the intervention to respectively 88% (305/347) and 74% (301/405) after. The estimated number of HIV-positive cases was respectively 303, 323 and 331 in the three periods. The proportion of patients receiving cotrimoxazole prophylaxis increased significantly from 47% (142/303) to 94% (303/323) and 86% (285/331, P < 0.05). Before the intervention, 87% (171/197) of the TB-HIV patients would have been missed when initiating antiretroviral treatment, compared to respectively 29% (60/210) and 36% (78/215) after the integration. The TB programme success rate increased from 56% (230/409) to 71% (319/447) in the third period (P < 0.05); however, there was no significant decrease in the default rate: 20% to 22% (P = 0.66) and 18% (P = 0.37). CONCLUSION: Integrated TB-HIV care has a very positive impact on the management of TB-HIV patients and on TB treatment outcomes

XMM-Newton Detection of Hot Gas in the Eskimo Nebula: Shocked Stellar Wind or Collimated Outflows?

The Eskimo Nebula (NGC 2392) is a double-shell planetary nebula (PN) known for the exceptionally large expansion velocity of its inner shell, ~90 km/s, and the existence of a fast bipolar outflow with a line-of-sight expansion velocity approaching 200 km/s. We have obtained XMM-Newton observations of the Eskimo and detected diffuse X-ray emission within its inner shell. The X-ray spectra suggest thin plasma emission with a temperature of ~2x10^6 K and an X-ray luminosity of L_X = (2.6+/-1.0)x10^31 (d/1150 pc)^2 ergs/s, where d is the distance in parsecs. The diffuse X-ray emission shows noticeably different spatial distributions between the 0.2-0.65 keV and 0.65-2.0 keV bands. High-resolution X-ray images of the Eskimo are needed to determine whether its diffuse X-ray emission originates from shocked fast wind or bipolar outflows.Comment: 4 pages, 2 figures, accepted in Astronomy and Astrophysics Letter

Hidden IR structures in NGC 40: signpost of an ancient born-again event

We present the analysis of infrared (IR) observations of the planetary nebula NGC 40 together with spectral analysis of its [WC]-type central star HD 826. Spitzer IRS observations were used to produce spectral maps centred at polycyclic aromatic hydrocarbons (PAH) bands and ionic transitions to compare their spatial distribution. The ionic lines show a clumpy distribution of material around the main cavity of NGC 40, with the emission from [Ar II] being the most extended, whilst the PAHs show a rather smooth spatial distribution. Analysis of ratio maps shows the presence of a toroidal structure mainly seen in PAH emission, but also detected in a Herschel PACS 70 mic image. We argue that the toroidal structure absorbs the UV flux from HD 826, preventing the nebula to exhibit lines of high-excitation levels as suggested by previous authors. We discuss the origin of this structure and the results from the spectral analysis of HD 826 under the scenario of a late thermal pulse.Comment: 10 pages, 10 figures; Accepted to MNRA

Integrating Stakeholder Input into Water Policy Development and Analysis

Agricultural water use is becoming an issue in much of the South due to population growth. Results of projects evaluating the impacts of conservation strategies aimed at reallocating or extending the life of water supplies are being met with great skepticism by stakeholder groups. In order to gain acceptance of results, it is essential that stakeholder groups be involved from the beginning in the identification of potential water conservation strategies and be kept informed throughout the project. The objective of this paper is to review previous attempts at involving stakeholders and the methodology currently being employed in the Ogallala Aquifer Project.conservation, Ogallala Aquifer, stakeholder, water policy, Agribusiness, Agricultural and Food Policy, Consumer/Household Economics, Q250, Q280,

Economic Evaluation of Wind Energy as an Alternative to Natural Gas Powered Irrigation

High natural gas prices have agricultural producers searching for alternative energy sources for irrigation. The economic feasibility of electric and hybrid (electric/wind) systems are evaluated as alternatives to natural gas powered irrigation. Texas Panhandle and Southern Kansas farms are assessed with a quarter-mile sprinkler system, three crops, and two pumping lifts. Breakeven points identify the price at which conversion from a natural gas irrigation system to an electric or hybrid system is cost effective. Results indicate electricity is a more feasible energy source for irrigation and policy changes such as net metering are necessary to make hybrid systems viable.electricity, irrigation, natural gas, wind energy, Agribusiness, Community/Rural/Urban Development, Environmental Economics and Policy, Farm Management, International Development, Land Economics/Use, Research and Development/Tech Change/Emerging Technologies, Resource /Energy Economics and Policy, Q12, Q20, Q42,