Tuberculosis Drug Resistance and Outcomes among Tuberculosis Inpatients in Lilongwe, Malawi

Setting/Objective: We evaluated clinical characteristics, yield of solid vs. liquid culture, polymerase chain reaction (PCR)-based drug-resistance profiles, and clinical outcomes of tuberculosis (TB) inpatients in Lilongwe, Malawi.Design: We enrolled adult patients admitted to the Bwaila TB Ward from Jan-Aug/2010. Evaluations included questionnaires, clinical exam, chest radiograph, HIV status, CD4 lymphocyte count, plasma HIVRNA and sputum analysis including Auramine-O stain, Lowenstein-Jensen (LJ) and Mycobacterial Growth Indicator Tube (MGIT) culture, and susceptibility testing using the HAIN GenoType® MTBDRplus.Results: Eighty-eight patients were enrolled (88% re-treatment, 42% smear positive, 93% pulmonary TB, 74% HIV co-infected). At baseline, 44/88 (50%) MGIT and 28 (32%) LJ cultures were positive with a mean time to positivity of 12.1 (Range 1-42) and 21.5 (Range 7-58) days, respectively. Four percent (3/77) of retreatment patients or 8% of the 38 MGIT+ PCR-confirmed retreatment cases had multi-drug resistant tuberculosis (MDR TB). One MDR TB patient was smear negative and only one MDR patient was identified with LJ. Lower mean hemoglobin at admission was associated with mortality (10.5 vs. 7.5; p<0.01; CI 101 9.8-11.0).Conclusions: The MDR TB burden among the retreatment population in Lilongwe, Malawi is similar to regional estimates by the WHO (7.7% 95% CI 0-18.1). MDR TB patients are not routinely identified with sputum smear or LJ, suggesting more efficient technology should be adopted

The hidden X-ray breaks in afterglow light curves

Gamma-Ray Burst (GRB) afterglow observations in the Swift era have a perceived lack of achromatic jet breaks compared to the BeppoSAX, or pre-Swift era. Specifically, relatively few breaks, consistent with jet breaks, are observed in the X-ray light curves of these bursts. If these breaks are truly missing, it has serious consequences for the interpretation of GRB jet collimation and energy requirements, and the use of GRBs as standard candles. Here we address the issue of X-ray breaks which are possibly 'hidden' and hence the light curves are misinterpreted as being single power-laws. We show how a number of precedents, including GRB 990510 & GRB 060206, exist for such hidden breaks and how, even with the well sampled light curves of the Swift era, these breaks may be left misidentified. We do so by synthesising X-ray light curves and finding general trends via Monte Carlo analysis. Furthermore, in light of these simulations, we discuss how to best identify achromatic breaks in afterglow light curves via multi-wavelength analysis.Comment: 4 pages, contributed talk, submitted to the proceedings of Gamma Ray Bursts 2007, Santa Fe, New Mexico, November 5-9 200

The impact of cessation or continuation of family violence on children

Children exposed to family violence are at risk for developing long-lasting problems. Family violence is a pervasive problem, however, studies comparing continuation with cessation of family violence are limited. Understanding the cessation or continuation of family violence on child development is a prerequisite to prevent enduring problems and develop interventions. This study compares posttraumatic stress and delinquent behavior of children aged between eight and eighteen years for whom severe violence continues to children for whom violence diminishes or ceases. Children (N = 162, 43% boys, mean age 12 years) and their parents reported to child protection services (CPS) with severe violence were included. Levels of family violence, posttraumatic stress and delinquent behavior were re-assessed after 18 months. Most families (74%) still experienced severe family violence at the second assessment despite involvement of CPS. Structural equation modelling was applied. In the group where violence diminished or stopped, delinquent behavior decreased. A decrease of posttraumatic stress only occurred when violence diminished but surprisingly no decrease was observed when violence stopped completely. The findings demonstrate that overall family violence is persistent. Differing paths can be discerned for delinquent behavior and posttraumatic stress, indicating different developmental and recovery pathways after cessation of family violence. Nonetheless, it is fair to state that specialized and long-term care is crucial

Dissecting magnetar variability with Bayesian hierarchical models

Neutron stars are a prime laboratory for testing physical processes under conditions of strong gravity, high density, and extreme magnetic fields. Among the zoo of neutron star phenomena, magnetars stand out for their bursting behaviour, ranging from extremely bright, rare giant flares to numerous, less energetic recurrent bursts. The exact trigger and emission mechanisms for these bursts are not known; favoured models involve either a crust fracture and subsequent energy release into the magnetosphere, or explosive reconnection of magnetic field lines. In the absence of a predictive model, understanding the physical processes responsible for magnetar burst variability is difficult. Here, we develop an empirical model that decomposes magnetar bursts into a superposition of small spike-like features with a simple functional form, where the number of model components is itself part of the inference problem. The cascades of spikes that we model might be formed by avalanches of reconnection, or crust rupture aftershocks. Using Markov Chain Monte Carlo (MCMC) sampling augmented with reversible jumps between models with different numbers of parameters, we characterise the posterior distributions of the model parameters and the number of components per burst. We relate these model parameters to physical quantities in the system, and show for the first time that the variability within a burst does not conform to predictions from ideas of self-organised criticality. We also examine how well the properties of the spikes fit the predictions of simplified cascade models for the different trigger mechanisms.Comment: accepted for publication in The Astrophysical Journal; code available at https://bitbucket.org/dhuppenkothen/magnetron, data products at http://figshare.com/articles/SGR_J1550_5418_magnetron_data/129242

SN 2007gr: a Normal Type Ic Supernova with a Mildly Relativistic Radio Jet?

A nearby type Ic supernova, SN 2007gr was observed with the EVN in two epochs 60 days apart (second observation also included the Green Bank Telescope). In both cases one of the EVN stations was the Westerbork Synthesis Radio Telescope (WSRT), which recorded the observational data not only in the VLBI mode, but also in its normal interferometric mode. Thus it provided an important reference observation. In the first epoch the fluxes measured by the VLBI network and the WSRT alone match well. However in the second epoch the peak brightness observed in the VLBI experiment is much lower than the total flux recorded by the WSRT. There could be multiple reasons for this discrepancy: a resolution effect, coherence losses in VLBI, or extended emission contaminating the WSRT measurement. With new WSRT observations we costrain the level of background emission and find that there is still a difference between the corrected total flux density and the VLBI peak brightness. If one assumes that this is dominated by resolution, this would correspond to an average apparent expansion speed of ~0.4c

GRB 030329: 3 years of radio afterglow monitoring

Radio observations of gamma-ray burst (GRB) afterglows are essential for our understanding of the physics of relativistic blast waves, as they enable us to follow the evolution of GRB explosions much longer than the afterglows in any other wave band. We have performed a three-year monitoring campaign of GRB 030329 with the Westerbork Synthesis Radio Telescopes (WSRT) and the Giant Metrewave Radio Telescope (GMRT). Our observations, combined with observations at other wavelengths, have allowed us to determine the GRB blast wave physical parameters, such as the total burst energy and the ambient medium density, as well as investigate the jet nature of the relativistic outflow. Further, by modeling the late-time radio light curve of GRB 030329, we predict that the Low-Frequency Array (LOFAR, 30-240 MHz) will be able to observe afterglows of similar GRBs, and constrain the physics of the blast wave during its non-relativistic phase.Comment: 5 pages, 2 figures, Phil. Trans. R. Soc. A, vol.365, p.1241, proceedings of the Royal Society Scientific Discussion Meeting, London, September 200

Expert statement for the management of hypovolemia in sepsis

Hypovolemia is frequent in patients with sepsis and may contribute to worse outcome. The management of these patients is impeded by the low quality of the evidence for many of the specific components of the care. In this paper, we discuss recent advances and controversies in this field and give expert statements for the management of hypovolemia in patients with sepsis including triggers and targets for fluid therapy and volumes and types of fluid to be given. Finally, we point to unanswered questions and suggest a roadmap for future research.Peer reviewe

Cognitive and attitudinal impacts of a university AIDS course: interdisciplinary education as a public health intervention.

This paper describes an interdisciplinary, variable credit-bearing university course on acquired immunodeficiency syndrome (AIDS) that enrolled 429 students. Pre- and post-course questionnaries were used to assess knowledge and attitudes relative to AIDS and these were compared to National Health Interview Survey findings. Considerable cognitive and attitudinal changes occurred over the course period. University courses, taught annually, were found to be an efficient mechanism for educating large numbers of future community leaders and professionals about AID