Six-Month Mortality among HIV-Infected Adults Presenting for Antiretroviral Therapy with Unexplained Weight Loss, Chronic Fever or Chronic Diarrhea in Malawi.

In sub-Saharan Africa, early mortality is high following initiation of antiretroviral therapy (ART). We investigated 6-month outcomes and factors associated with mortality in HIV-infected adults being assessed for ART initiation and presenting with weight loss, chronic fever or diarrhea, and with negative TB sputum microscopy

Screening for HIV-Associated Tuberculosis and Rifampicin Resistance before Antiretroviral Therapy Using the Xpert MTB/RIF Assay: A Prospective Study

In a prospective study, Stephen Lawn and colleagues find that pre-ART screening with Xpert MTB/RIF increased tuberculosis case detection by 45% compared to smear microscopy in HIV-positive patients at high risk of TB risk. AE competing interests must also pull through to the proof. “The Academic Editor, Madhukar Pai, declares that he consults for the Bill & Melinda Gates Foundation (BMGF). The BMGF supported FIND which was involved in the development of the Xpert MTB/RIF assay. He also co-chairs the Stop TB Partnership's New Diagnostics Working Group that was involved in the WHO endorsement of the Xpert assay.” Linked: Scott pmed.1001061; Evans pmed.1001064; Dowdy pmed.100106

Subcritical crack growth in fibrous materials

We present experiments on the slow growth of a single crack in a fax paper sheet submitted to a constant force $F$. We find that statistically averaged crack growth curves can be described by only two parameters : the mean rupture time $\tau$ and a characteristic growth length $\zeta$. We propose a model based on a thermally activated rupture process that takes into account the microstructure of cellulose fibers. The model is able to reproduce the shape of the growth curve, the dependence of $\zeta$ on $F$ as well as the effect of temperature on the rupture time $\tau$. We find that the length scale at which rupture occurs in this model is consistently close to the diameter of cellulose microfibrils

Failure time and microcrack nucleation

The failure time of samples of heterogeneous materials (wood, fiberglass) is studied as a function of the applied stress. It is shown that in these materials the failure time is predicted with a good accuracy by a model of microcrack nucleation proposed by Pomeau. It is also shown that the crack growth process presents critical features when the failure time is approached.Comment: 13 pages, 4 figures, submitted to Europhysics Letter

Use of wind-up fetal Doppler versus Pinard for fetal heart rate intermittent monitoring in labour: a randomised clinical trial.

OBJECTIVES: In resource-poor settings, the standard of care to inform labour management is the partograph plus Pinard stethoscope for intermittent fetal heart rate (FHR) monitoring. We compared FHR monitoring in labour using a novel, robust wind-up handheld Doppler with the Pinard as a primary screening tool for abnormal FHR on perinatal outcomes. DESIGN: Prospective equally randomised clinical trial. SETTING: The labour and delivery unit of a teaching hospital in Kampala, Uganda. PARTICIPANTS: Of the 2042 eligible antenatal women, 1971 women in active term labour, following uncomplicated pregnancies, were randomised to either the standard of care or not. INTERVENTION: Intermittent FHR monitoring using Doppler. PRIMARY OUTCOME MEASURES: Incidence of FHR abnormality detection, intrapartum stillbirth and neonatal mortality prior to discharge. RESULTS: Age, parity, gestational age, mode of delivery and newborn weight were similar between study groups. In the Doppler group, there was a significantly higher rate of FHR abnormalities detected (incidence rate ratio (IRR)=1.61, 95% CI 1.13 to 2.30). However, in this group, there were also higher though not statistically significant rates of intrapartum stillbirths (IRR=3.94, 0.44 to 35.24) and neonatal deaths (IRR=1.38, 0.44 to 4.34). CONCLUSIONS: Routine monitoring with a handheld Doppler increased the identification of FHR abnormalities in labour; however, our trial did not find evidence that this leads to a decrease in the incidence of intrapartum stillbirth or neonatal death. TRIAL REGISTRATION NUMBER: Clinical Trails.gov (1000031587)

Dynamical stability of the crack front line

Dynamical stability of the crack front line that propagates between two plates is studied numerically using the simple two-dimensional mass-spring model. It is demonstrated that the straight front line is unstable for low speed while it becomes stable for high speed. For the uniform model, the roughness exponent in the slower speed region is fairly constant around 0.4 and there seems to be a rough-smooth transition at a certain speed. For the inhomogeneous case with quenched randomness, the transition is gradual.Comment: 14 pages, 7 figure

Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities

Mikkel Oestergaard and colleagues develop annual estimates for neonatal mortality rates and neonatal deaths for 193 countries for 1990 to 2009, and forecasts into the future