TB and HIV are public health problems, which have a synergistic effect to each other. Despite the decreasing burden of these two diseases they still make a significant contribution to mortality. ...Tanzania is among the 30 high TB and HIV burden countries.
Routine data over 6 years from people living with HIV (PLHIV) attending health facilities in three regions of Northern Tanzania were analyzed, showing mortality trends from 2012 to 2017 for HIV and HIV/TB subpopulations. Poisson regression with frailty model adjusting for clustering at health facility level was used to analyze the data to determine mortality rate ratios (RR) and 95% confidence intervals (95%CI).
Among all PLHIV the overall mortality rate was 28.4 (95% CI 27.6-29.2) deaths per 1000 person-years. For PLHIV with no evidence of TB the mortality rates was 26.2 (95% CI 25.4-27.0) per 1000 person-years, and for those with HIV/TB co-infection 57.8 (95% CI 55.6-62.3) per 1000 person-years. After adjusting for age, sex, residence, WHO stage, and bodyweight, PLHIV with TB co-infection had 40% higher mortality than those without TB (RR 1.4; 95% CI 1.24-1.67).
Over the 6-year period mortality rates for HIV/TB patients were consistently higher than for PLHIV who have no TB. More efforts should be directed into improving nutritional status among HIV patients, as it has destructive interaction with TB for mortality. This will improve patients' body weight and CD4 counts which are protective against mortality. Among PLHIV attention should be given to those who are in WHO HIV stage 3 or 4 and having TB co-infection.
Problem. Factors related to MDRTB mortality in Tanzania have not been adequately explored and reported. Objectives. To determine demographic, clinical, radiographic, and laboratory factors associated ...with MDRTB mortality in a Tanzanian TB Referral Hospital. Methodology. This was a cross-sectional study with 193 participants. Demographic, clinical, laboratory, and radiological data were collected, and their associations with mortality among MDRTB patients were determined. Results and Conclusions. Cough was the commonest finding among these MDRTB patients, with 179 (92.75%) of them presenting with cough, followed by chest X-ray consolidation in 156 patients (80.83%) and history of previous TB treatment in 151 patients (78.24%). Cigarette smoking, HIV positivity, and low CD4 counts were significantly associated with MDRTB mortality, p values of 0.034, 0.044, and 0.048, respectively. Fever on the other hand was at the borderline with p value of 0.059. We conclude that cigarette smoking and HIV status are significant risk factors for mortality among MDRTB patients. HIV screening should continually be emphasized among patients and the general community for early ARTs initiation. Based on the results from our study, policy makers and public health personnel should consider addressing tobacco cessation as part of national TB control strategy.
Background:
HIV and tuberculosis (TB) are leading infectious diseases, with a high risk of co-infection. The risk of TB in people living with HIV (PLHIV) is high soon after sero-conversion and ...increases as the CD4 counts are depleted.
Methodology:
We used routinely collected data from Care and Treatment Clinics (CTCs) in three regions in northern Tanzania. All PLHIV attending CTCs between January 2012 to December 2017 were included in the analysis. TB incidence was defined as cases started on anti-TB medications divided by the person-years of follow-up. Poisson regression with frailty models were used to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for predictors of TB incidences among HIV positive patients.
Results:
Among 78,748 PLHIV, 405 patients developed TB over 195,296 person-years of follow-up, giving an overall TB incidence rate of 2.08 per 1,000 person-years. There was an increased risk of TB incidence, 3.35 per 1,000 person-years, in hospitals compared to lower level health facilities. Compared to CD4 counts of <350 cells/μl, a high CD4 count was associated with lower TB incidence, 81% lower for a CD4 count of 350–500 cells/μl (IRR 0.19, 95% CI 0.04–0.08) and 85% lower for those with a CD4 count above 500 cells/μl (IRR 0.15, 95% CI 0.04–0.64). Independently, those taking ART had 66% lower TB incidences (IRR 0.34, 95% CI 0.15–0.79) compared to those not taking ART. Poor nutritional status and CTC enrollment between 2008 and 2012 were associated with higher TB incidences IRR 9.27 (95% CI 2.15–39.95) and IRR 2.97 (95% CI 1.05–8.43), respectively.
Discussion:
There has been a decline in TB incidence since 2012, with exception of the year 2017 whereby there was higher TB incidence probably due to better diagnosis of TB following a national initiative. Among HIV positive patients attending CTCs, poor nutritional status, low CD4 counts and not taking ART treatment were associated with higher TB incidence, highlighting the need to get PLHIV on treatment early, and the need for close monitoring of CD4 counts. Data from routinely collected and available health services can be used to provide evidence of the epidemiological risk of TB.
Software Defined Radio (SDR) uses a processor, a special receiver and software that play the main parts of the receiver (mixer, filters, amplifiers, modulators, demodulators, etc.) and it is quite ...advantageous for its flexibility and compact size as it reduces the amount of hardware components while adapting for different needs. This work briefly presents the SDR concept and approach for obtaining satellite telemetries and imagery in the context of different modulation schemes, link budget requirements and different satellites types. Two case studies are presented for supporting affordable ground segment and promoting satellites projects in Brazil. Reception from the 1st Brazilian picosatellite, Tancredo-1, with specific software developed, UbaTM is presented for obtaining satellite raw telemetries, convert them to engineering value and friendly present on user screen. A series of support software packages are then introduced so that one can pipeline various operations and automate tasks in the ground station. Finally, a second study case was performed in order to receive NOAA class satellites imagery over VHF band and decoded by specific software freely available. Using the proposed SDR approach, it can adapt to projects mainly those with a limited budget and outreach for major inclusion on space topics in Brazil.
is a Gram-negative, immobile, aerobic nosocomial opportunistic coccobacillus that causes pneumonia, septicemia, and urinary tract infections in immunosuppressed patients. There are no commercially ...available alternative antimicrobials, and multi-drug resistance is an urgent concern that requires emergency measures and new therapeutic strategies. This study evaluated a multi-drug-resistant
whole-cell vaccine, inactivated and adsorbed on an aluminum hydroxide-chitosan (mAhC) matrix, in an
sepsis model in immunosuppressed mice by cyclophosphamide (CY). CY-treated mice were divided into immunized, non-immunized, and adjuvant-inoculated groups. Three vaccine doses were given at 0D, 14D, and 28D, followed by a lethal dose of 4.0 × 10
CFU/mL of
. Immunized CY-treated mice underwent a significant humoral response, with the highest IgG levels and a higher survival rate (85%); this differed from the non-immunized CY-treated mice, none of whom survived (
< 0.001), and from the adjuvant group, with 45% survival (
< 0.05). Histological data revealed the evident expansion of white spleen pulp from immunized CY-treated mice, whereas, in non-immunized and adjuvanted CY-treated mice, there was more significant organ tissue damage. Our results confirmed the proof-of-concept of the immune response and vaccine protection in a sepsis model in CY-treated mice, contributing to the advancement of new alternatives for protection against
infections.
Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. ...Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda.
Methods: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries.
Results: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic.
Conclusion: A wide gap exists between current evidence-based standards and current levels of provider competence.
The present work deals with recent results on the sampling distribution of the magnitude-squared coherence (also called just coherence) estimate between a random (Gaussian) and a periodic signal, in ...order to obtain analytical critical values, alternative expressions for the probability density function (PDF) as well as the variance and bias of the estimate. A comparison with the more general case of coherence estimation when both signals are Gaussian was also provided. The results indicate that the smaller the true coherence (TC) values the closer both distributions become. The behaviour of variance and bias as a function of the number of data segments and the TC is similar for both coherence estimates. Additionally, the effect of a normalizing function (Fisher's z transform) in the coherence estimated between a random and a periodic signal was also evaluated and normality has been nearly achieved. However, the variance was less equalized in comparison with coherence estimate between two Gaussian signals.
First Steps in Data Privacy Cases Plave, Lee J.; Edson, John W.
Franchise law journal,
04/2018, Letnik:
37, Številka:
4
Journal Article
Recenzirano
...the likelihood and frequency at which data breach lawsuits make it past the pleading stage would significantly impact a company's data protection policies and litigation strategies. In practical ...terms, most data breach cases involving franchise systems are either decided in the early stages- for example, a Motion to Dismiss on the issue of standing-or settled. ...standing issues have a significant impact on whether a class action brought against a franchisor and its franchisees is dismissed at an early stage or whether the case proceeds ahead (e.g., if standing is found); and if so, the matter is typically resolved by settlement before a trial on the merits. ...Eleventh Circuits View: Standing Found In In re Horizon Healthcare Services, Inc. Data Breach Litigation, the Third Circuit held that a procedural violation of the FCRA was, on its own, suffi cient to establish standing for the plaintiffs.96 Horizon Healthcare Services resulted from the theft of two laptops containing "differing amounts of member information" from Horizon Healthcare Services, Inc.'s headquarters.97 Shortly after learning of the break-in, Horizon notified its members that their personal information may have been compromised and offered free credit monitoring services.98 Four Horizon members subsequently filed suit.99 In their complaint, the plaintiffs did not allege their identities were stolen as a result of the breach.100 Instead, they argued Horizon had violated the FCRA by "furnishing" their information in an unauthorized fashion by allowing that information to fall into the hands of thieves and by failing to adopt reasonable procedures to keep the information confidential.101 The district court dismissed the case, holding that the plaintiffs did not have standing because they had not suffered a "cognizable injury. ...Seventh, Eighth, and D.C. Circuits: Standing Called into Question Courts in other circuits have been more reluctant to confer standing to plaintiffs on the mere basis of a statutory violation.
This paper presents a theoretical and experimental comparison of two techniques of optical fiber current sensors (OFCS) based on the Faraday Effect: the power and the degree of polarization (DOP) ...methods. The DOP method is shown to be insensitive to state of polarization (SOP) changes induced by environmental conditions. A maximum variation of 0.4% in the DOP value in the entire range of applied current from 0 to 100 A was measured. It is the first time to our knowledge that this fact was experimentally verified. Also, for the first time known it is reported that zero current response, DOP = 0.996, is in agreement with the theoretical expected value of unitary DOP. Besides, the theoretical and experimental normalized DOP is shown to have a maximum difference of 0.33% in the entire range of applied current. On the other hand, the power method OFCS is greatly affected by SOP changes. In order to be used in a practical application, its complexity must be increased by the use, for example, of polarization maintaining fibers instead of standard fibers used in the DOP method, increasing the cost of the sensor element.
Abstract Objective Cases meeting diagnostic criteria for severe pre-eclampsia or eclampsia were reviewed in three countries to determine timeliness and effectiveness of care. Method Cases were ...retrospectively selected from 11 emergency obstetric care facilities and medical records reviewed by trained obstetricians. Result Of 91 cases (Benin, 28; Ecuador, 25; Jamaica, 38), 74% were correctly treated with anticonvulsant and 77% with antihypertensive therapy. The median interval to treat eclampsia (anticonvulsant, 28 min; antihypertensive, 77 min) was shorter than for severe pre-eclampsia (anticonvulsant, 45 min; antihypertensive, 85 min). Two in three cases (65%) received anticonvulsant but only 41% received antihypertensive therapy within 60 min of diagnosis. While 74% of eclamptics had been delivered within 12 h, only 39% of severe pre-eclamptics were delivered within 24 h. Conclusion Timeliness can be studied in developing countries. Its objective measurement is a first step towards improving this component of care.
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