Passive Versus Active Tuberculosis Case Finding and Isoniazid Preventive Therapy Among Household Contacts in a Rural District of Malawi.

SETTING: Thyolo district, rural Malawi. OBJECTIVES: To compare passive with active case finding among household contacts of smear-positive pulmonary tuberculosis (TB) patients for 1) TB case detection and 2) the proportion of child contacts aged under 6 years who are placed on isoniazid (INH) preventive therapy. DESIGN: Cross-sectional study. METHODS: Passive and active case finding was conducted among household contacts, and the uptake of INH preventive therapy in children was assessed. RESULTS: There were 189 index TB cases and 985 household contacts. Human immunodeficiency virus (HIV) prevalence among index cases was 69%. Prevalence of TB by passive case finding among 524 household contacts was 0.19% (191/100000), which was significantly lower than with active finding among 461 contacts (1.74%, 1735/100000, P = 0.01). Of 126 children in the passive cohort, 22 (17%) received INH, while in the active cohort 25 (22%) of 113 children received the drug. Transport costs associated with chest X-ray (CXR) screening were the major reason for low INH uptake. CONCLUSIONS: Where the majority of TB patients are HIV-positive, active case finding among household contacts yields nine times more TB cases and is an opportunity for reducing TB morbidity and mortality. The need for a CXR is an obstacle to the uptake of INH prophylaxis

Completeness of the Coulomb scattering wave functions

Completeness of the eigenfunctions of a self-adjoint Hamiltonian, which is the basic ingredient of quantum mechanics, plays an important role in nuclear reaction and nuclear structure theory. However, until now, there was no a formal proof of the completeness of the eigenfunctions of the two-body Hamiltonian with the Coulomb interaction. Here we present the first formal proof of the completeness of the two-body Coulomb scattering wave functions for repulsive unscreened Coulomb potential. To prove the completeness we use the Newton's method [R. Newton, J. Math Phys., 1, 319 (1960)]. The proof allows us to claim that the eigenfunctions of the two-body Hamiltonian with the potential given by the sum of the repulsive Coulomb plus short-range (nuclear) potentials also form a complete set. It also allows one to extend the Berggren's approach of modification of the complete set of the eigenfunctions by including the resonances for charged particles. We also demonstrate that the resonant Gamow functions with the Coulomb tail can be regularized using Zel'dovich's regularization method.Comment: 12 pages and 1 figur

Perimetric deficits in chronic glaucoma

peer reviewe

WHO Clinical Staging of HIV Infection and Disease, Tuberculosis and Eligibility for Antiretroviral Treatment: Relationship to CD4 Lymphocyte Counts.

SETTING: Thyolo district, Malawi. OBJECTIVES: To determine in HIV-positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). DESIGN: Cross-sectional study. METHODS: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. RESULTS: A CD4 lymphocyte count of < or = 350 cells/microl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. CONCLUSIONS: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of < or = 350 cells/microl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy

Assessment of bovine tuberculosis risk factors based on nationwide molecular epidemiology

This assessment aimed to elaborate a statistical nationwide model for analyzing the space-time dynamics of bovine tuberculosis in search of potential risk factors that could be used to better target surveillance measures. A database comprising Mycobacterium bovis molecular profiles from all isolates obtained from Belgian outbreaks during the 1995-to-2006 period (n = 415) allowed the identification of a predominant spoligotype (SB0162). Various databases compiling 49 parameters to be tested were queried using a multiple stepwise logistic regression to assess bovine tuberculosis risk factors. Two isolate datasets were analyzed: the first included all Mycobacterium bovis isolates, while the second included only data related to the SB0162 type strain. When all Mycobacterium bovis isolates were included in the model, several risk factors were identified: history of bovine tuberculosis in the herd (P < 0.001), proximity of an outbreak (P < 0.001), cattle density (P < 0.001), and annual amplitude of mean middle-infrared temperature (P < 0.001). The approach restricted to the predominant SB0162 type strain additionally highlighted the proportion of movements from an infected area during the current year as a main risk factor (P = 0.009). This study identified several risk factors for bovine tuberculosis in cattle, highlighted the usefulness of molecular typing in the study of bovine tuberculosis epidemiology, and suggests a difference of behavior for the predominant type strain. It also emphasizes the role of animals' movements in the transmission of the disease and supports the importance of controlling trade movements

Revisiting battistini: Pleistocene coastal evolution of southwestern madagascar

The study of paleo shorelines, particularly of those formed during the late Quaternary, provides robust insights into past climate variability. Advances in surveying techniques and chronological methodologies have dramatically improved the inter-comparability of regional and basin-wide paleo shoreline surveys. However, these advances have been applied unevenly across the globe. This is especially true in southwestern Madagascar, where, in the 1960s and 1970s, emerged Pleistocene beach and reef facies were first described in detail and dated to Marine Isotope Stage (MIS) 5a using U–Th alpha activity counting by french geologist René Battistini. Now, 50 years on, no further analysis of the coastal sequence has been made. In this study, we present an updated late Pleistocene coastal evolution model for the southwestern Madagascar coast. Utilizing a combination of Structure-from-Motion/Multi-View Stereo techniques and differential Global Navigation Satellite System surveys, we have created five high-resolution 3D outcrop reconstructions that have, in turn, been chronologically constrained using 10 U-series ages from both in situ and reworked coral samples. Our data suggest that the emerged reef was deposited during MIS 5e (∼125 ka), then was covered by intertidal and beach sediment (including redeposited coral clasts of MIS 5e age), and finally capped off by thick eolianites. This sequence would suggest that the local sea level must have remained stable throughout MIS 5e in order to allow for the progradation of both the beach and reef environments

Equivalence between the real time Feynman histories and the quantum shutter approaches for the "passage time" in tunneling

We show the equivalence of the functions $G_{\rm p}(t)$ and $|\Psi(d,t)|^2$ for the ``passage time'' in tunneling. The former, obtained within the framework of the real time Feynman histories approach to the tunneling time problem, using the Gell-Mann and Hartle's decoherence functional, and the latter involving an exact analytical solution to the time-dependent Schr\"{o}dinger equation for cutoff initial waves