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

Ultra-high-Q microcavity operation in H2O and D2O

Optical microcavities provide a possible method for boosting the detection sensitivity of biomolecules. Silica-based microcavities are important because they are readily functionalized, which enables unlabeled detection. While silica resonators have been characterized in air, nearly all molecular detections are performed in solution. Therefore, it is important to determine their performance limits in an aqueous environment. In this letter, planar microtoroid resonators are used to measure the relationship between quality factor and toroid diameter at wavelengths ranging from visible to near-IR in both H2O and D2O, and results are then compared to predictions of a numerical model. Quality factors (Q) in excess of 10^8, a factor of 100 higher than previous measurements in an aqueous environment, are observed in both H2O and D2O

Markertrait association analysis of functional gene markers for provitamin A levels across diverse tropical yellow maize inbred lines

Background: Biofortification of staple crops is a cost effective and sustainable approach that can help combatvitamin A and other micronutrient deficiencies in developing countries. PCR -based DNA markers distinguishingalleles of three key genes of maize endosperm carotenoid biosynthesis (PSY1, lcyE and crtRB1) have been developedto facilitate maize provitamin A biofortification via marker assisted selection. Previous studies of these functionalDNA markers revealed inconsistent effects. The germplasm previously employed for discovering andvalidating these functional markers was mainly of temperate origin containing low frequencies of the favourableallele of the most significant polymorphism, crtRB1-5_TE. Here, we investigate the vitamin A biofortification potentialof these DNA markers in a germplasm panel of diverse tropical yellow maize inbred lines, with mixed geneticbackgrounds of temperate and tropical germplasm to identify the most effective diagnostic markers forvitamin A biofortification.Results: The functional DNA markers crtRB1-5_TE and crtRB1-3_TE were consistently and strongly associated withprovitamin A content across the tropical maize inbred lines tested. The alleles detected by these two functionalmarkers were in high linkage disequilibrium (R2 = 0.75) and occurred in relatively high frequency (18%). Genotypescombining the favourable alleles at the two loci (N = 20) displayed a 3.22 fold average increase in _-carotenecontent compared to those genotypes lacking the favourable alleles (N = 106). The PSY1 markers were monomorphicacross all of the inbred lines. The functional DNA markers for lcyE were associated with lutein, and with the ratio ofcarotenoids in the alpha and beta branches, but not with provitamin A levels. However, the combined effects of thetwo genes were stronger than their individual effects on all carotenoids.Conclusions: Tropical maize inbred lines harbouring the favourable alleles of the crtRB1-5_TE and 3_TE functionalmarkers produce higher levels of provitamin A. Such maize lines can be used as donor parents to speed up thedevelopment of provitamin A biofortified tropical maize varieties adapted to growing conditions and consumerpreferences, providing a route towards mitigation of vitamin A malnutrition in Sub-Saharan Africa

Meaningful & Sustainable School Improvement with Distributed Leadership

School leadership is broadly acknowledged to be the lynchpin for school success. Yet, amongst the countless demands that school leaders face, making wise leadership choices is increasingly challenging. On what should leaders focus their attention and how should they prioritize their improvement efforts? How can they identify, understand, and make headway on the difficult challenges that will substantially enhance the educational experiences of their students, and how can they bring their faculty together with commitment around these improvement efforts? In this essay we lay out a research-informed framework for advancing meaningful school improvement using a distributed leadership approach. This report was funded by the Bill & Melinda Gates Foundation. Opinions in this paper reflect those of the authors and do not necessarily reflect those of the Consortium for Policy Research in Education (CPRE), the University of Pennsylvania Graduate School of Education, that of the funder

Secure self-calibrating quantum random bit generator

Random bit generators (RBGs) are key components of a variety of information processing applications ranging from simulations to cryptography. In particular, cryptographic systems require "strong" RBGs that produce high-entropy bit sequences, but traditional software pseudo-RBGs have very low entropy content and therefore are relatively weak for cryptography. Hardware RBGs yield entropy from chaotic or quantum physical systems and therefore are expected to exhibit high entropy, but in current implementations their exact entropy content is unknown. Here we report a quantum random bit generator (QRBG) that harvests entropy by measuring single-photon and entangled two-photon polarization states. We introduce and implement a quantum tomographic method to measure a lower bound on the "min-entropy" of the system, and we employ this value to distill a truly random bit sequence. This approach is secure: even if an attacker takes control of the source of optical states, a secure random sequence can be distilled.Comment: 5 pages, 2 figure

Concurrent Suppression of Virus Replication and Rescue of Movement-Defective Virus in Transgenic Plants Expressing the Coat Protein of Potato Virus X

AbstractA line of transgenic tobacco expressing the coat protein (CP) of potato virus X (PVX) was resistant against a broad spectrum of PVX strains. Inoculation of leaves and protoplasts with PVX expressing the jellyfish green fluorescent protein reporter gene revealed that this resistance mechanism suppressed PVX replication in the initially infected cell and systemic spread of the virus. Cell-to-cell movement was also slower in the resistant plants. The resistance at the level of replication was effective against wild-type PVX and also against movement-defective isolates with a frameshift mutation or deletion in the CP ORF. However, the cell-to-cell movement defect of the mutant viruses was rescued on the resistant plants. Based on these results it is proposed that the primary resistance mechanism is at the level of replication

Don't Thrash: How to Cache Your Hash on Flash

This paper presents new alternatives to the well-known Bloom filter data structure. The Bloom filter, a compact data structure supporting set insertion and membership queries, has found wide application in databases, storage systems, and networks. Because the Bloom filter performs frequent random reads and writes, it is used almost exclusively in RAM, limiting the size of the sets it can represent. This paper first describes the quotient filter, which supports the basic operations of the Bloom filter, achieving roughly comparable performance in terms of space and time, but with better data locality. Operations on the quotient filter require only a small number of contiguous accesses. The quotient filter has other advantages over the Bloom filter: it supports deletions, it can be dynamically resized, and two quotient filters can be efficiently merged. The paper then gives two data structures, the buffered quotient filter and the cascade filter, which exploit the quotient filter advantages and thus serve as SSD-optimized alternatives to the Bloom filter. The cascade filter has better asymptotic I/O performance than the buffered quotient filter, but the buffered quotient filter outperforms the cascade filter on small to medium data sets. Both data structures significantly outperform recently-proposed SSD-optimized Bloom filter variants, such as the elevator Bloom filter, buffered Bloom filter, and forest-structured Bloom filter. In experiments, the cascade filter and buffered quotient filter performed insertions 8.6-11 times faster than the fastest Bloom filter variant and performed lookups 0.94-2.56 times faster.Comment: VLDB201

Effects of Capsaicin and Evodiamine Ingestion on Energy Expenditure and Fat Oxidation at Rest and After Moderately-Intense Exercise in Young Men

Capsaicin and evodiamine are two thermogenic agents each recognized for their ability to stimulate the sympathetic nervous system and are thus found in many dietary supplements. Therefore, the purpose of this study was to observe the effects that capsaicin and evodiamine have on hemodynamics, energy expenditure, and markers of lipid oxidation while at rest and after a single bout of moderate-intensity exercise in young men. In a randomized, cross-over design, 11 men orally ingested 500 mg of capsaicin, evodiamine, or placebo while at rest after 30 minutes of resting energy expenditure assessment using open-circuit spirometry. After an additional 30 minutes of rest after supplement ingestion, resting energy expenditure was assessed again for 30 minutes. After the second resting energy expenditure assessment, treadmill exercise was performed until expending approximately 500 kilocalories (~30 minutes) at 65% peak oxygen consumption. Energy expenditure was assessed for another 30 minutes into the post-exercise period. Heart rate and blood pressure, core temperature, and venous blood samples were obtained 30 minutes before and one hour after supplement ingestion (i.e. immediately pre-exercise), and immediately after and 45 minutes post-exercise. Markers of lipid oxidation (serum glycerol, free fatty acids, serum glucose, epinephrine, and norepinephrine) were determined spectrophotometrically and with ELISA. Two-way analyses of variance (ANOVA) were performed for each dependent variable (p ≤ 0.05). Significant main effects for Time existed for hemodynamics, energy expenditure, serum catecholamines and markers of fat oxidation immediately following exercise (p \u3c 0.05). However, no significant Supplement x Time interactions were noted for any criterion variable (p \u3e 0.05), suggesting no preferential difference between supplements. Neither capsaicin nor evodiamine, at a single dose of 500 mg, are effective at inducing thermogenesis and increasing fat oxidation at rest or during exercise in young men

Therapeutic Surgical Management of Palpable Melanoma Groin Metastases: Superficial or Combined Superficial and Deep Groin Lymph Node Dissection

Item does not contain fulltextBACKGROUND: Management of patients with clinically detectable lymph node metastasis to the groin is by ilioinguinal or combined superficial and deep groin dissection (CGD) according to most literature, but in practice superficial groin dissection (SGD) only is still performed in some centers. The aim of this study is to evaluate the experience in CGD versus SGD patients in our center. METHODS: Between 1991 and 2009, 121 therapeutic CGD and 48 SGD were performed in 169 melanoma patients with palpable groin metastases at our institute. Median follow-up was 20 and, for survivors, 45 months. RESULTS: In this heterogeneous group of patients, overall (OS) and disease-free survival, local control rates, and morbidity rates were not significantly different between CGD and SGD patients. However, CGD patients had a trend towards more chronic lymphedema. Superficial lymph node ratio, the number of positive superficial lymph nodes, and the presence of deep nodes were prognostic factors for survival. CGD patients with involved deep lymph nodes (24.8%) had estimated 5-year OS of 12% compared with 40% with no involved deep lymph nodes (p = 0.001). Preoperative computed tomography (CT) scan had high negative predictive value of 91% for detection of pelvic nodal involvement. CONCLUSIONS: This study demonstrated that survival and local control do not differ for patients with palpable groin metastases treated by CGD or SGD. Patients without pathological iliac nodes on CT might safely undergo SGD, while CGD might be reserved for patients with multiple positive nodes on SGD and/or positive deep nodes on CT scan

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