Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.

BACKGROUND: In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda. METHODS AND FINDINGS: Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045). CONCLUSION: Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART

Status of the James Webb Space Telescope Integrated Science Instrument Module System

The Integrated Science Instrument Module (ISIM) of the James Webb Space Telescope (JWST) is discussed from a systems perspective with emphasis on development status and advanced technology aspects. The ISIM is one of three elements that comprise the JWST space vehicle and is the science instrument payload of the JWST. The major subsystems of this flight element and their build status are described

JWST Near-Infrared Detectors: Latest Test Results

The James Webb Space Telescope, an infrared-optimized space telescope being developed by NASA for launch in 2013, will utilize cutting-edge detector technology in its investigation of fundamental questions in astrophysics. JWST's near infrared spectrograph, NIRSpec utilizes two 2048 x 2048 HdCdTe arrays with Sidecar ASIC readout electronics developed by Teledyne to provide spectral coverage from 0.6 microns to 5 microns. We present recent test and calibration results for the NIRSpec flight arrays as well as data processing routines for noise reduction and cosmic ray rejection

Detector Arrays for the James Webb Space Telescope Near-Infrared Spectrograph

The James Webb Space Telescope's (JWST) Near Infrared Spectrograph (NIRSpec) incorporates two 5 micron cutoff (lambda(sub co) = 5 microns) 2048x2048 pixel Teledyne HgCdTe HAWAII-2RG sensor chip assemblies. These detector arrays, and the two Teledyne SIDECAR application specific integrated circuits that control them, are operated in space at T approx. 37 K. In this article, we provide a brief introduction to NIRSpec, its detector subsystem (DS), detector readout in the space radiation environment, and present a snapshot of the developmental status of the NIRSpec DS as integration and testing of the engineering test unit begins

James Webb Space Telescope Near-Infrared Spectrograph: Dark Performance of the First Flight Candidate Detector Arrays

The James Webb Space Telescope (JWST) Near Infrared Spectrograph (NIRSpec) incorporates two 5 micron cutoff (lambda(sub co) = 5 micron) 2048x2048 pixel Teledyne HgCdTe HAWAII-2RG sensor chip assemblies. These detector arrays, and the two Teledyne SIDECAR application specific integrated circuits that control them, are operated in space at T approx. 37 K. This article focuses on the measured performance of the first flight-candidate, and near-flight candidate, detector arrays. These are the first flight-packaged detector arrays that meet NIRSpec's challenging 6 e(-) rms total noise requirement

Fate and Complex Pathogenic Effects of Dioxins and Polychlorinated Biphenyls in Obese Subjects before and after Drastic Weight Loss

BACKGROUND: In humans, persistent organic pollutants (POPs) are stored primarily in adipose tissue. Their total body burden and their contribution to obesity-associated diseases remain unclear. OBJECTIVES: We characterized POP total body burden and their redistribution in obese individuals before and after drastic weight loss and compared these values with a variety of molecular, biological, and clinical parameters. METHODS: Seventy-one obese subjects were enrolled and underwent bariatric surgery. Blood and adipose tissue samples were obtained at different times from these individuals as well as from 18 lean women. RESULTS: POP content (17 dioxins/furans and 18 polychlorinated biphenyl congeners) in different adipose tissue territories was similar, allowing us to assess total POP body burden from a single biopsy. Total POP body burden was 2 to 3 times higher in obese than in lean individuals. We also found increased expression of some POP target genes in obese adipose tissue. Drastic weight loss led to increased serum POPs and, within 6-12 months, to a significant 15% decrease in total polychlorinated biphenyl body burden. Importantly, serum POP levels were positively correlated with liver toxicity markers and lipid parameters, independently of age and body mass index. CONCLUSIONS: POP content in adipose tissue and serum correlate with biological markers of obesity-related dysfunctions. Drastic weight loss leads to a redistribution of POPs and to a moderate decrease of their total body burden

Alveolar Hemorrhage and Renal Microangiopathy in Systemic Lupus Erythematosus

AbstractContext.—Acute alveolar hemorrhage in systemic lupus erythematosus usually occurs as a pulmonary-renal syndrome. In most cases, the lungs show “bland” alveolar hemorrhage with little or no inflammation. Whether this alveolar injury is similar to the better-defined noninflammatory renal lupus vasculopathy is unresolved.Objectives.—To investigate the relationships and the mechanisms of small vascular injury in the lung and kidney of 2 lupus patients who died of diffuse AH.Methods.—We investigated the relationship of AH to immune complex deposition in the lungs of 6 patients with systemic lupus erythematosus and correlated the findings with glomerular and vascular disease in the kidney. Lung and kidney were studied by light, immunofluorescence, and/or electron microscopy; apoptosis was investigated using in situ nick-end labeling.Results.—The clinical course of 2 patients was complicated by alveolar hemorrhage, and the lungs of these patients revealed alveolar wall immune complex deposits and bland alveolar hemorrhage. These 2 patients had World Health Organization class IV lupus nephritis and renal arterioles involved by a noninflammatory lupus vasculopathy. Apoptosis was identified in the lupus microangiopathy and in alveolar walls within areas of alveolar hemorrhage. Alveolar wall immune complex deposits were not found in 4 patients who had a lupus glomerulonephritis but did not have renal lupus vasculopathy. Apoptosis was not seen in renal arterioles or lungs of these 4 cases, except in areas of diffuse alveolar damage or herpesvirus pneumonia.Conclusions.—Our findings indicate that alveolar hemorrhage in systemic lupus erythematosus, characterized by bland alveolar wall changes, is pathogenetically similar to the lupus microangiopathy of the kidney. In both lung and kidney, the pathogenesis of the microvascular injury appears to be related to immune complex deposition and the induction of apoptosis.</jats:p