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

Study of the 12C+12C fusion reactions near the Gamow energy

The fusion reactions 12C(12C,a)20Ne and 12C(12C,p)23Na have been studied from E = 2.10 to 4.75 MeV by gamma-ray spectroscopy using a C target with ultra-low hydrogen contamination. The deduced astrophysical S(E)* factor exhibits new resonances at E <= 3.0 MeV, in particular a strong resonance at E = 2.14 MeV, which lies at the high-energy tail of the Gamow peak. The resonance increases the present non-resonant reaction rate of the alpha channel by a factor of 5 near T = 8x10^8 K. Due to the resonance structure, extrapolation to the Gamow energy E_G = 1.5 MeV is quite uncertain. An experimental approach based on an underground accelerator placed in a salt mine in combination with a high efficiency detection setup could provide data over the full E_G energy range.Comment: 4 Pages, 4 figures, accepted for publication in Phys. Rev. Let

High sensitivity nanoparticle detection using optical microcavities

We demonstrate a highly sensitive nanoparticle and virus detection method by using a thermal-stabilized reference interferometer in conjunction with an ultrahigh-Q microcavity. Sensitivity is sufficient to resolve shifts caused by binding of individual nanobeads in solution down to a record radius of 12.5 nm, a size approaching that of single protein molecules. A histogram of wavelength shift versus nanoparticle radius shows that particle size can be inferred from shift maxima. Additionally, the signal-to-noise ratio for detection of Influenza A virus is enhanced to 38:1 from the previously reported 3:1. The method does not use feedback stabilization of the probe laser. It is also observed that the conjunction of particle-induced backscatter and optical-path-induced shifts can be used to enhance detection signal-to-noise

Strong Interactions of Single Atoms and Photons near a Dielectric Boundary

Modern research in optical physics has achieved quantum control of strong interactions between a single atom and one photon within the setting of cavity quantum electrodynamics (cQED). However, to move beyond current proof-of-principle experiments involving one or two conventional optical cavities to more complex scalable systems that employ N >> 1 microscopic resonators requires the localization of individual atoms on distance scales < 100 nm from a resonator's surface. In this regime an atom can be strongly coupled to a single intracavity photon while at the same time experiencing significant radiative interactions with the dielectric boundaries of the resonator. Here, we report an initial step into this new regime of cQED by way of real-time detection and high-bandwidth feedback to select and monitor single Cesium atoms localized ~100 nm from the surface of a micro-toroidal optical resonator. We employ strong radiative interactions of atom and cavity field to probe atomic motion through the evanescent field of the resonator. Direct temporal and spectral measurements reveal both the significant role of Casimir-Polder attraction and the manifestly quantum nature of the atom-cavity dynamics. Our work sets the stage for trapping atoms near micro- and nano-scopic optical resonators for applications in quantum information science, including the creation of scalable quantum networks composed of many atom-cavity systems that coherently interact via coherent exchanges of single photons.Comment: 8 pages, 5 figures, Supplemental Information included as ancillary fil

Shared leadership and group identification in healthcare: : The leadership beliefs of clinicians working in interprofessional teams

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Interprofessional Care on 28 February 2017, available online: http://www.tandfonline.com/doi/full/10.1080/13561820.2017.1280005.Despite the proposed benefits of applying shared and distributed leadership models in healthcare, few studies have explored the leadership beliefs of clinicians and ascertained whether differences exist between professions. The current paper aims to address these gaps and additionally, examine whether clinicians’ leadership beliefs are associated with the strength of their professional and team identifications. An online survey was responded to by 229 healthcare workers from community interprofessional teams in mental health settings across the East of England. No differences emerged between professional groups in their leadership beliefs; all professions reported a high level of agreement with shared leadership. A positive association emerged between professional identification and shared leadership i.e. participants who expressed the strongest level of profession identification also reported the greatest agreement with shared leadership. The same association was demonstrated for team identification and shared leadership. The findings highlight the important link between group identification and leadership beliefs, suggesting that strategies that promote strong professional and team identifications in interprofessional teams are likely to be conducive to clinicians supporting principles of shared leadership. Future research is needed to strengthen this link and examine the leadership practices of healthcare workers.Peer reviewe

Thromboembolic risk with IVIg: Incidence and risk factors in inflammatory neuropathy patients

Our objective was to evaluate whether IV immunoglobulin (IVIg) increases the risk of thromboembolic events in neurology outpatients with inflammatory neuropathies, as there is conflicting evidence supporting this hypothesis, mainly from non-neurologic cohorts. We investigated this question over 30 months in our cohort of patients with inflammatory neuropathies receiving regular IVIg anOur objective was to evaluate whether IV immunoglobulin (IVIg) increases the risk of thromboembolic events in neurology outpatients with inflammatory neuropathies, as there is conflicting evidence supporting this hypothesis, mainly from non-neurologic cohorts. We investigated this question over 30 months in our cohort of patients with inflammatory neuropathies receiving regular IVIg and found a greater incidence of arterial and venous thromboembolic events than population-based rates determined by hospital admissions data. Vascular risk factors were more common in the event group but there were no IVIg administration factors that contributed to the risk. This study suggests that IVIg may have a small but contributory role in determining thromboembolic risk in the inflammatory neuropathy cohort and more evidence is required before it is clear whether the current primary prevention guidelines are appropriate in this group of patients.d found a greater incidence of arterial and venous thromboembolic events than population-based rates determined by hospital admissions data. Vascular risk factors were more common in the event group but there were no IVIg administration factors that contributed to the risk. This study suggests that IVIg may have a small but contributory role in determining thromboembolic risk in the inflammatory neuropathy cohort and more evidence is required before it is clear whether the current primary prevention guidelines are appropriate in this group of patients

Heavy ion beam measurement of the hydration of cementitious materials

The setting and development of strength of Portland cement concrete depends upon the reaction of water with various phases in the Portland cement. Nuclear resonance reaction analysis (NRRA) involving the 1H(15N,α,γ)12C reaction has been applied to measure the hydrogen depth profile in the few 100 nm thick surface layer that controls the early stage of the reaction. Specific topics that have been investigated include the reactivity of individual cementitious phases and the effects of accelerators and retarders

The influence of distributed leadership on teachers' organizational commitment: a multilevel approach

In the present study the effects of a cooperative leadership team, distributed leadership, participative decision-making, and context variables on teachers' organizational commitment are investigated. Multilevel analyses on data from 1522 teachers indicated that 9% of the variance in teachers' organizational commitment is attributable to differences between schools. The analyses revealed that especially the presence of a cooperative leadership team and the amount of leadership support played a significantly positive key role in predicting teachers' organizational commitment. Also, participative decision-making and distribution of the supportive leadership function had a significant positive impact on teachers' organizational commitment. In contrast, distribution of the supervisory leadership function and teachers' job experience had a significant negative impact