Socioeconomic and behavioral factors associated with tuberculosis diagnostic delay in Lima, Peru

Early detection and diagnosis of tuberculosis (TB) is a global priority. Prolonged symptom duration prior to TB diagnosis is associated with increased morbidity, mortality and risk of transmission. We aimed to determine socioeconomic and behavioral factors associated with diagnostic delays among patients with TB. Data were collected from 105 patients with TB using a semi-structured interview guide in Lima, Peru. Factors associated with diagnostic delay were analyzed using negative binomial regression. The median delay from when symptoms commenced and the first positive diagnostic sample in public health facilities was 57 days (interquartile range (IQR): 28-126). In multivariable analysis, greater diagnostic delay was independently associated with patient older age; female sex; lower personal income prior to diagnosis; living with fewer people; and having more visits to professional health facilities prior to diagnosis (all p<0.05). Patients who first sought care at a private health facility had more visits overall to professional health facilities prior to diagnosis than those who first sought care from public or insured employee health facilities and had longer diagnostic delay in analysis adjusted for age and sex. Patients with TB were significantly more likely to first self-medicate than to visit professional health facilities prior to diagnosis (p=0.003). Thus, diagnostic delay was prolonged, greatest among older, low-income women and varied according to the type of care sought by individuals when their symptoms commenced. These findings suggest that TB case finding initiatives should target vulnerable groups in informal and private health facilities, where many patients with TB first seek healthcare

Why wait? The social determinants underlying tuberculosis diagnostic delay.

BACKGROUND: Early detection and diagnosis of tuberculosis remain major global priorities for tuberculosis control. Few studies have used a qualitative approach to investigate the social determinants contributing to diagnostic delay and none have compared data collected from individual, community, and health-system levels. We aimed to characterize the social determinants that contribute to diagnostic delay among persons diagnosed with tuberculosis living in resource-constrained settings. METHODS/PRINCIPLE FINDINGS: Data were collected in public health facilities with high tuberculosis incidence in 19 districts of Lima, Peru. Semi-structured interviews with persons diagnosed with tuberculosis (n = 105) and their family members (n = 63) explored health-seeking behaviours, community perceptions of tuberculosis and socio-demographic circumstances. Focus groups (n = 6) were conducted with health personnel (n = 35) working in the National Tuberculosis Program. All interview data were transcribed and analysed using a grounded theory approach. The median delay between symptom onset and the public health facility visit that led to the first positive diagnostic sample was 57 days (interquartile range 28-126). The great majority of persons diagnosed with tuberculosis distrusted the public health system and sought care at public health facilities only after exhausting other options. It was universally agreed that persons diagnosed with tuberculosis faced discrimination by public and health personnel. Self-medication with medicines bought at local pharmacies was reported as the most common initial health-seeking behaviour due to the speed and low-cost of treatment in pharmacies. Most persons diagnosed with tuberculosis initially perceived their illness as a simple virus. CONCLUSIONS: Diagnostic delay was common and prolonged. When individuals reached a threshold of symptom severity, they addressed their health with the least time-consuming, most economically feasible, and well-known healthcare option available to them. In high-burden settings, more human and material resources are required to promote tuberculosis case-finding initiatives, reduce tuberculosis associated stigma and address the social determinants underlying diagnostic delay

The Peru approach against the COVID-19 infodemic: Insights and strategies

The COVID-19 epidemic has spawned an "infodemic,"with excessive and unfounded information that hinders an appropriate public health response. This perspective describes a selection of COVID-19 fake news that originated in Peru and the government's response to this information. Unlike other countries, Peru was relatively successful in controlling the infodemic possibly because of the implementation of prison sentences for persons who created and shared fake news. We believe that similar actions by other countries in collaboration with social media companies may offer a solution to the infodemic problem.Revisión por pare

Caracterizacion de la diversidad citogenetica de Physalis peruviana L. (aguaymanto) en dos ecotipos

Physalis peruviana L (aguaymanto), es una solanácea, herbácea perenne, de crecimiento rápido, se distribuye desde los 1500 a 3000m de altitud, se desarrolla&nbsp; entre 15-20°C, característico por su gran importancia nutricional y terapéutica (anticancérigeno, antipirético e inmunomodulador) de crecimiento rápido, en terrenos bien o mal drenados con escasa demanda de nitrógeno. En el estudio se caracterizó el cariotipo de dos ecotipos de Physalis peruviana L, uno proveniente del gemoplasma de K´ayra (Cusco) y semillas del ecotipo Huayoccari (Urubamba), las semillas en estudio alcanzaron entre 18 y 21 días de rizogénesis, a partir de las cuales se realizaron, pretratamiento, hidrólisis y coloración de meristemos. Se determinó niveles de ploidía de 2n=24 para el ecotipo K´ayra y 2n=36 para el ecotipo Huayoccari, la dotación cromosómica metacéntrica&nbsp; fue agrupada en 3 grupos: Grupo A: pares 1,2,4,5,y 7, Grupo B: pares 3,6,8,9, y 10, Grupo C: pares 11 y 12, de acuerdo a la clasificación de Levan, 1964. Los ecotipos exhibieron variación citogenética, lo que se atribuiría al proceso evolutivo de la especie

?Puede el dinero electr?nico facilitar el otorgamiento de microcreditos? : an?lisis del caso del Parque Industrial de Villa El Salvador - sector calzado

El 17 de enero de 2013 se public? la Ley N? 29985, Ley que regula las caracter?sticas b?sicas del dinero electr?nico como instrumento de inclusi?n financiera. Es as? que el Per? se sum? a un grupo de pa?ses que a la fecha han implementado el dinero electr?nico, buscando fomentar una mayor inclusi?n financiera. En dicho contexto, se decidi? evaluar si el dinero electr?nico puede ser una herramienta de pago que permita facilitar el otorgamiento de microcr?ditos a los microempresarios y, considerando las caracter?sticas puntuales del dinero electr?nico, se crey? conveniente tener como objeto de la presente investigaci?n a los microempresarios del rubro de calzado del Parque Industrial de Villa El Salvador. El objetivo general de esta investigaci?n es determinar si el dinero electr?nico puede facilitar el otorgamiento de microcr?ditos a los microempresarios del rubro de calzado del Parque Industrial de Villa El Salvador

Active Learning and Proofreading for Delineation of Curvilinear Structures

Many state-of-the-art delineation methods rely on supervised machine learning algorithms. As a result, they require manually annotated training data, which is tedious to obtain. Furthermore, even minor classification errors may significantly affect the topology of the final result. In this paper we propose a generic approach to addressing both of these problems by taking into account the influence of a potential misclassification on the resulting delineation. In an Active Learning context, we identify parts of linear structures that should be annotated first in order to train a classifier effectively. In a proofreading context, we similarly find regions of the resulting reconstruction that should be verified in priority to obtain a nearly-perfect result. In both cases, by focusing the attention of the human expert on potential classification mistakes which are the most critical parts of the delineation, we reduce the amount of required supervision. We demonstrate the effectiveness of our approach on microscopy images depicting blood vessels and neurons

Are there Social Spillovers in Consumers’ Security Assessments of Payment Instruments?

Even though security of payments has long been identified as an important aspect of the consumer payment experience, recent literature fails to appropriately assess the extent of social spillovers among payment users. We test for the existence and importance of such spillovers by analyzing whether social influence affects consumers’ perceptions of the security of payment instruments. Based on a 2008–2014 annual panel data survey of consumers, we find strong evidence of social spillovers in payment markets: others’ perceptions of security of payment instruments exert a positive influence on one’s own payment security perceptions. The significant and robust results imply that a consumer’s assessments of security converge to his peers’ average assessment: a 10 percent change in the divergence between one’s own security rating and peers’ average rating will result in a 7 percent change in one’s own rating in the next period. The results are robust to many specifications and do not change when we control for actual fraud or crime data. Our results indicate that spillovers rather than reflection appear to be the cause, although separating the two causes is very difficult (Manski 1993). In particular, the spillovers are stronger for people who experience an exogenous shock to security perception, people who have more social interactions, and younger consumers, who are more likely to be influenced by social media. We also examine the effects of social spillovers on payment behavior (that is, on decisions regarding payment adoption and use). Our results indicate that social spillovers have a rather limited impact on payment behavior, as others’ perceptions seem to affect one’s own payment behavior mainly indirectly through the effect on one’s own perceptions

Incorporation of DPP6a and DPP6K Variants in Ternary Kv4 Channel Complex Reconstitutes Properties of A-type K Current in Rat Cerebellar Granule Cells

Dipeptidyl peptidase-like protein 6 (DPP6) proteins co-assemble with Kv4 channel α-subunits and Kv channel-interacting proteins (KChIPs) to form channel protein complexes underlying neuronal somatodendritic A-type potassium current (ISA). DPP6 proteins are expressed as N-terminal variants (DPP6a, DPP6K, DPP6S, DPP6L) that result from alternative mRNA initiation and exhibit overlapping expression patterns. Here, we study the role DPP6 variants play in shaping the functional properties of ISA found in cerebellar granule (CG) cells using quantitative RT-PCR and voltage-clamp recordings of whole-cell currents from reconstituted channel complexes and native ISA channels. Differential expression of DPP6 variants was detected in rat CG cells, with DPP6K (41±3%)>DPP6a (33±3%)>>DPP6S (18±2%)>DPP6L (8±3%). To better understand how DPP6 variants shape native neuronal ISA, we focused on studying interactions between the two dominant variants, DPP6K and DPP6a. Although previous studies did not identify unique functional effects of DPP6K, we find that the unique N-terminus of DPP6K modulates the effects of KChIP proteins, slowing recovery and producing a negative shift in the steady-state inactivation curve. By contrast, DPP6a uses its distinct N-terminus to directly confer rapid N-type inactivation independently of KChIP3a. When DPP6a and DPP6K are co-expressed in ratios similar to those found in CG cells, their distinct effects compete in modulating channel function. The more rapid inactivation from DPP6a dominates during strong depolarization; however, DPP6K produces a negative shift in the steady-state inactivation curve and introduces a slow phase of recovery from inactivation. A direct comparison to the native CG cell ISA shows that these mixed effects are present in the native channels. Our results support the hypothesis that the precise expression and co-assembly of different auxiliary subunit variants are important factors in shaping the ISA functional properties in specific neuronal populations

SIRNA-Directed In Vivo Silencing of Androgen Receptor Inhibits the Growth of Castration-Resistant Prostate Carcinomas

BACKGROUND: Prostate carcinomas are initially dependent on androgens, and castration or androgen antagonists inhibit their growth. After some time though, tumors become resistant and recur with a poor prognosis. The majority of resistant tumors still expresses a functional androgen receptor (AR), frequently amplified or mutated. METHODOLOGY/PRINCIPAL FINDINGS: To test the hypothesis that AR is not only expressed, but is still a key therapeutic target in advanced carcinomas, we injected siRNA targeting AR into mice bearing exponentially growing castration-resistant tumors. Quantification of siRNA into tumors and mouse tissues demonstrated their efficient uptake. This uptake silenced AR in the prostate, testes and tumors. AR silencing in tumors strongly inhibited their growth, and importantly, also markedly repressed the VEGF production and angiogenesis. CONCLUSIONS/SIGNIFICANCE: Our results demonstrate that carcinomas resistant to hormonal manipulations still depend on the expression of the androgen receptor for their development in vivo. The siRNA-directed silencing of AR, which allows targeting overexpressed as well as mutated isoforms, triggers a strong antitumoral and antiangiogenic effect. siRNA-directed silencing of this key gene in advanced and resistant prostate tumors opens promising new therapeutic perspectives and tools