Unpaid community volunteers – effective providers of directly observed therapy (DOT) in rural South Africa

Objective. To illustrate successes and difficulties for the South African National Tuberculosis Progranune in a rural area.Design. Prospective cohort study.Setting. Sekhukhuneland, Provincial Health Service Southern Region, Northern Province, South Africa.Subjects. All patients diagnosed with tuberculosis (TB) in thecatchment area of four rural hospitals between January 1997 and June 1999,Main outcome measures. Standard outcomes for TB treatment as defined by the World Health Organisation. Treatment failure, treatment interruption and death were grouped as poor outcomes.Results. One thousand four hundred and seventy-six people were diagnosed with TB. The majority (76%) had smearpositive pulmonary disease. Treatment was given by directly observed therapy (DOT) throughout in all but 15 instances. Excluding 10 subjects with known multidrug-resistant TB (MDRTB), 723 (66%) were cured, 68 (6%) completed treatment, 73 (7%) interrupted treatment, 37 (3%) failed treatment, 66 (6%) transferred out, and 134 (12%) died. Of the 920 initially smear-positive patients who survived the first 2 months to receive DOT in the community, 693 (75%) were supervised by unpaid community volunteers. Poor outcomes were no more common among patients supervised by these volunteers than among patients supervised by professional health care workers. Male gender (odds ratio 1.38,95% confidence interval 1.02, 1.87) was significantly associated with a poor outcome.Conclusion. Although there were difficulties, the national progranune was successfully applied with no additional funds or facilities. Explanations for the high death rate and poor outcomes for men need to be found. Great efforts will be required to preserve the quality of the TB programme if it is devolved to primary care level

Hydrogen production during the irradiation of gaseous organic compounds: advantage of an extracted beam

ACE, Accélérateur, NIMBInternational audienceThis paper presents a fundamental study of the radiolysis of gaseous organic molecules induced by proton beam. For that purpose, a specific extracted beam line associated with a gas irradiation cell was set up on the 4 MV facility of the Institut de Physique Nucléaire of Lyon. The first experiments have been performed with gaseous alkanes and alkenes. The gaseous species formed during irradiation are analysed by an on-line gas chromatography instrument equipped with two detectors. In order to test our experimental faiclity, we have studied the influence of irradiation parameters (duration, beam intensity, pressure) on the production of hydrogen. In the case of propane, the radiolytic yield value of hydrogen G(H$_2$) is equal to 3.7 for total does in the range of 0.4 to 2.3 MGy at atmospheric pressure

Hydrographic observations from the US/PRC Cooperative Program in the Western Equatorial Pacific Ocean, cruises 1-4

In support of the Tropical Oceans and Global Atmosphere (TOGA) program, investigators from Woods Hole Oceanographic Institution (WHOI), NOAA Pacific Marine Envionmental Laboratory and the State Oceanic Administration (SOA) from both Qingdao (First Institute) and Guangzhou (South China Sea Branch) conducted hydrographic observations aboard the Chinese Research vessels Xiang Yang Hong 5 and Xiang Yang Hong 14 in the western equatorial Pacific. The objective of this component of the TOGA program was to document the water mass property distributions of the western equatorial Pacific Ocean and describe the oceanic velocity field. The four cruises summarized here were conducted during the period November 1985 to June 1988 and are the first half of an eight cruise repeated survey of the region scheduled to be completed in spring 1990. Conductivity-Temperatue-Depth-Oxygen (CTD/02) stations were collected to a minimum cast depth of 2,500 m or the bottom when shallower. The cruises reoccupied the same stations to provide temporal information. Summarized listings of CTD/O2 data together with selected physical properties of sea water for these cruises are provided here, as well as a description of the hardware used and an explanation of the data reduction tehniques employed.Funding was provided by the National Oceanic and Atmospheric Administration

Population-level emergence of bedaquiline and clofazimine resistance-associated variants among patients with drug-resistant tuberculosis in southern Africa: a phenotypic and phylogenetic analysis

Background: Bedaquiline and clofazimine are important drugs in the treatment of drug-resistant tuberculosis and are commonly used across southern Africa, although drug susceptibility testing is not routinely performed. In this study, we did a genotypic and phenotypic analysis of drug-resistant Mycobacterium tuberculosis isolates from cohort studies in hospitals in KwaZulu-Natal, South Africa, to identify resistance-associated variants (RAVs) and assess the extent of clofazimine and bedaquiline cross-resistance. We also used a comprehensive dataset of whole-genome sequences to investigate the phylogenetic and geographical distribution of bedaquiline and clofazimine RAVs in southern Africa. Methods: In this study, we included M tuberculosis isolates reported from the PRAXIS study of patients with drug-resistant tuberculosis treated with bedaquiline (King Dinuzulu Hospital, Durban) and three other cohort studies of drug-resistant tuberculosis in other KwaZulu-Natal hospitals, and sequential isolates from six persistently culture-positive patients with extensively drug-resistant tuberculosis at the KwaZulu-Natal provincial referral laboratory. Samples were collected between 2013 and 2019. Microbiological cultures were done as part of all parent studies. We sequenced whole genomes of included isolates and measured bedaquiline and clofazimine minimum inhibitory concentrations (MICs) for isolates identified as carrying any Rv0678 variant or previously published atpE, pepQ, and Rv1979c RAVs, which were the subject of the phenotypic study. We combined all whole-genome sequences of M tuberculosis obtained in this study with publicly available sequence data from other tuberculosis studies in southern Africa (defined as the countries of the Southern African Development Community), including isolates with Rv0678 variants identified by screening public genomic databases. We used this extended dataset to reconstruct phylogenetic relationships across lineage 2 and 4 M tuberculosis isolates. Findings: We sequenced the whole genome of 648 isolates from 385 patients with drug-resistant tuberculosis recruited into cohort studies in KwaZulu-Natal, and 28 isolates from six patients from the KwaZulu-Natal referral laboratory. We identified 30 isolates with Rv0678 RAVs from 16 (4%) of 391 patients. We did not identify any atpE, pepQ, or Rv1979c RAVs. MICs were measured for 21 isolates with Rv0678 RAVs. MICs were above the critical concentration for bedaquiline resistance in nine (43%) of 21 isolates, in the intermediate category in nine (43%) isolates, and within the wild-type range in three (14%) isolates. Clofazimine MICs in genetically wild-type isolates ranged from 0·12-0·5 μg/mL, and in isolates with RAVs from 0·25-4·0 μg/mL. Phylogenetic analysis of the extended dataset including M tuberculosis isolates from southern Africa resolved multiple emergences of Rv0678 variants in lineages 2 and 4, documented two likely nosocomial transmission events, and identified the spread of a possibly bedaquiline and clofazimine cross-resistant clone in eSwatini. We also identified four patients with pepQ frameshift mutations that may confer resistance. Interpretation: Bedaquiline and clofazimine cross-resistance in southern Africa is emerging repeatedly, with evidence of onward transmission largely due to Rv0678 mutations in M tuberculosis. Roll-out of bedaquiline and clofazimine treatment in the setting of limited drug susceptibility testing could allow further spread of resistance. Designing strong regimens would help reduce the emergence of resistance. Drug susceptibility testing is required to identify where resistance does emerge. Funding: Wellcome Trust, National Institute of Allergy and Infectious Diseases and National Center for Advancing Translational Sciences of the National Institutes of Health

On being a good Bayesian

Bayesianism is fast becoming the dominant paradigm in archaeological chronology construction. This paradigm shift has been brought about in large part by widespread access to tailored computer software which provides users with powerful tools for complex statistical inference with little need to learn about statistical modelling or computer programming. As a result, we run the risk that such software will be reduced to the status of black boxes. This would be a dangerous position for our community since good, principled use of Bayesian methods requires mindfulness when selecting the initial model, defining prior information, checking the reliability and sensitivity of the software runs and interpreting the results obtained. In this article, we provide users with a brief review of the nature of the care required and offer some comments and suggestions to help ensure that our community continues to be respected for its philosophically rigorous scientific approach

Shallow seafloor gas emissions near Heard and McDonald Islands on the Kerguelen Plateau, Southern Indian Ocean

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Spain, E. A., Johnson, S. C., Hutton, B., Whittaker, J. M., Lucieer, V., Watson, S. J., Fox, J. M., Lupton, J., Arculus, R., Bradney, A., & Coffin, M. F. Shallow seafloor gas emissions near Heard and McDonald Islands on the Kerguelen Plateau, Southern Indian Ocean. Earth and Space Science, 7(3), (2020): e2019EA000695, doi:10.1029/2019EA000695.Bubble emission mechanisms from submerged large igneous provinces remains enigmatic. The Kerguelen Plateau, a large igneous province in the southern Indian Ocean, has a long sustained history of active volcanism and glacial/interglacial cycles of sedimentation, both of which may cause seafloor bubble production. We present the results of hydroacoustic flare observations around the underexplored volcanically active Heard Island and McDonald Islands on the Central Kerguelen Plateau. Flares were observed with a split‐beam echosounder and characterized using multifrequency decibel differencing. Deep‐tow camera footage, water properties, water column δ3He, subbottom profile, and sediment δ13C and δ34S data were analyzed to consider flare mechanisms. Excess δ3He near McDonald Islands seeps, indicating mantle‐derived input, suggests proximal hydrothermal activity; McDonald Islands flares may thus indicate CO2, methane, and other minor gas bubbles associated with shallow diffuse hydrothermal venting. The Heard Island seep environment, with subbottom acoustic blanking in thick sediment, muted 3He signal, and δ13C and δ34S fractionation factors, suggest that Heard Island seeps may either be methane gas (possibly both shallow biogenic methane and deeper‐sourced thermogenic methane related to geothermal heat from onshore volcanism) or a combination of methane and CO2, such as seen in sediment‐hosted geothermal systems. These data provide the first evidence of submarine gas escape on the Central Kerguelen Plateau and expand our understanding of seafloor processes and carbon cycling in the data‐poor southern Indian Ocean. Extensive sedimentation of the Kerguelen Plateau and additional zones of submarine volcanic activity mean additional seeps or vents may lie outside the small survey area proximal to the islands.We thank the Australian Marine National Facility (MNF) for its support in the form of sea time on RV Investigator , support personnel, scientific equipment, and data management. We also thank the captain, crew, and fellow scientists of RV Investigator voyage IN2016_V01. We also thank specifically the following: T. Martin, F. Cooke, S. L. Sow, N. Bax, J. Ford, and F. Althaus, CSIRO (Commonwealth Scientific and Industrial Research Organisation); Echoview Software Pty. Ltd. (Hobart, Australia); C. Dietz and C. Cook, Central Science Laboratory, University of Tasmania; C. Wilkinson and T. Baumberger, National Oceanic and Atmospheric Administration; R. Carey, University of Tasmania; T. Holmes, Institute for Marine and Antarctic Studies, University of Tasmania; N. Polmear; and A. Post, Geoscience Australia. The overall science of the project is supported by Australian Antarctic Science Program (AASP) grant 4338. E.S.' PhD research is supported by the Australian Research Council's Special Research Initiative Antarctic Gateway Partnership (Project ID SR140300001) and by an Australian Government Research Training Program Scholarship. S.C.J. is supported by iCRAG under SFI, European Regional Development Fund, and industry partners, as well as ANZIC‐IODP. J.M.W. is supported by ARC grant DE140100376 and DP180102280. This is PMEL publication number 4910. All IN2016_V01 data and samples acquired on IN2016_V01 are made publicly available in accordance with MNF policy

Plume Impingement Analysis for the European Service Module Propulsion System

Plume impingement analyses were performed for the European Service Module (ESM) propulsion system Orbital Maneuvering System engine (OMS-E), auxiliary engines, and reaction control system (RCS) engines. The heat flux from plume impingement on the solar arrays and other surfaces are evaluated. This information is used to provide inputs for the ESM thermal analyses and help determine the optimal configuration for the RCS engines

Double-Layer Systems at Zero Magnetic Field

We investigate theoretically the effects of intralayer and interlayer exchange in biased double-layer electron and hole systems, in the absence of a magnetic field. We use a variational Hartree-Fock-like approximation to analyze the effects of layer separation, layer density, tunneling, and applied gate voltages on the layer densities and on interlayer phase coherence. In agreement with earlier work, we find that for very small layer separations and low layer densities, an interlayer-correlated ground state possessing spontaneous interlayer coherence (SILC) is obtained, even in the absence of interlayer tunneling. In contrast to earlier work, we find that as a function of total density, there exist four, rather than three, distinct noncrystalline phases for balanced double-layer systems without interlayer tunneling. The newly identified phase exists for a narrow range of densities and has three components and slightly unequal layer densities, with one layer being spin polarized, and the other unpolarized. An additional two-component phase is also possible in the presence of sufficiently strong bias or tunneling. The lowest-density SILC phase is the fully spin- and pseudospin-polarized ``one-component'' phase discussed by Zheng {\it et al.} [Phys. Rev. B {\bf 55}, 4506 (1997)]. We argue that this phase will produce a finite interlayer Coulomb drag at zero temperature due to the SILC. We calculate the particle densities in each layer as a function of the gate voltage and total particle density, and find that interlayer exchange can reduce or prevent abrupt transfers of charge between the two layers. We also calculate the effect of interlayer exchange on the interlayer capacitance.Comment: 35 pages, 19 figures included. To appear in PR