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

The Queen Square Encephalitis Multidisciplinary Team Meeting - experience over three years, pre and post the COVID-19 pandemic

Background: Patients with suspected encephalitis continue to represent a diagnostic and therapeutic challenge, even in highly resourced centres. In February 2018, we set up a monthly in-person multidisciplinary team meeting (MDT). We describe the experience and outcomes of the MDT over three years. Methods: A retrospective analysis was performed to summarise patient demographics, MDT outcomes and final diagnoses. Results: Over the three-year period, 324 discussions of 238 patients took place. Cases were diverse; approximately 40% related to COVID-19 or brain infection, 40% autoimmune or other inflammatory disorders and 20% encephalitis mimics or uncertain aetiologies. Feedback from an online survey sent to referring teams and attendees highlighted the value of the MDT; 94% reported the discussion was useful and 69% reported resulting change in patient management. Conclusions: Multidisciplinary input is crucial in this challenging area, ensuring that all diagnostic avenues are explored and opening doors to novel diagnostics and therapeutics. It also supports clinicians dealing with unwell patients, including in centres where less specialist input is available, and when decisions have to be made where there is little or no evidence base

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

National level indicators for gender, poverty, food security, nutrition and health in Climate-Smart Agriculture (CSA) activities

At the global, regional and national levels, governments, donors, research institutions, non-government organizations and private companies are more strategically linking climate change and agriculture development activities, through initiatives such as the Global Alliance for Climate-Smart Agriculture (CSA). In this context, it is necessary to have robust metrics and indicators for measuring progress towards CSA-related goals. This requires strategic selection of indicators to assess the type of impact (negative/positive) of adaptation and mitigation activities on specific societal groups (e.g. ethnic groups, women, youth, etc.) to ensure livelihoods are positively impacted by CSA interventions. Gender, poverty, food security, nutrition and health indicators have not been extensively used in CSA programming and planning to date. In this paper, we review a range of gender, poverty, food security, nutrition and health indicators relevant for national planning processes for CSA promotion and scale out. We focus on the CSA CPs developed by the International Center for Tropical Agriculture (CIAT) in collaboration with the CGIAR research program on Climate Change, Agriculture, and Food Security (CCAFS). The CSA CPs are being developed as an instrument to open dialogues on the baseline situation, identifying opportunities, and challenges for CSA in various countries. The CPs are generated by the CGIAR CCAFS program with national partners, especially those involved in CSA related planning processes, to feed into analytical multi-stakeholder processes to prioritize CSA investment portfolios for scale-up and scale out. Using a ranking system based on data relevance, availability, and applicability to multiple national contexts, we identified a set of indicators that respond to the need for better integration of gender, poverty, food security, nutrition and health concerns when approaching CSA. Strengthened integration of poverty reduction, food security and gender equality indicators into CSA assessments, including the CPs, has been identified by CCAFS as a priority to strengthen the focus on resilience/adaptation efforts, specifically highlighting evidences of gender differences. It can also serve to highlight potential gaps in availability of and access to resources and capacities to adopt CSA practices and technologies among different societal groups (women, men, youth, ethnic groups). Rather than re-invent new indicators, it is important that, where possible, existing national-level indicators can be repurposed for tracking CSA impacts over time on poverty reduction, food security and gender equality outcomes

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

Cavity QED with Diamond Nanocrystals and Silica Microspheres

Normal mode splitting is observed in a cavity QED system, in which nitrogen vacancy centers in diamond nanocrystals are coupled to whispering gallery modes in a silica microsphere. The composite nanocrystal-microsphere system takes advantage of the exceptional spin properties of nitrogen vacancy centers as well as the ultra high quality factor of silica microspheres. The observation of the normal mode splitting indicates that the dipole optical interaction between the relevant nitrogen vacancy center and whispering gallery mode has reached the strong coupling regime of cavity QED