HIV screening among newly diagnosed TB patients : a cross sectional study in Lima, Peru

Background: Since 2006, the Peruvian National TB program (NTP) recommends voluntary counseling and testing (VCT) for all tuberculosis (TB) patients. Responding to the differential burden of both diseases in Peru, TB is managed in peripheral health facilities while HIV is managed in referral centers. This study aims to determine the coverage of HIV screening among TB patients and the characteristics of persons not screened. Methods: From March 2010 to December 2011 we enrolled new smear-positive pulmonary TB adults in 34 health facilities in a district in Lima. NTP staff offered VCT to all TB patients. Patients with an HIV positive result were referred for confirmation tests and management. We interviewed patients to collect their demographic and clinical characteristics and registered if patients opted in or out of the screening. Results: Of the 1295 enrolled TB patients, nine had a known HIV diagnosis. Of the remaining, 76.1% (979) were screened for HIV. Among the 23.9% (307) not screened, 38.4% (118) opted out of the screening. TB patients at one of the health care facilities of the higher areas of the district (OR = 3.38, CI 95% 2.17-5.28 for the highest area and OR = 2.82, CI 95% 1. 78-4.49 for the high area) as well as those reporting illegal drug consumption (OR = 1.65, CI 95% 1.15-2.37) were more likely not to be screened. Twenty-four were HIV positive (1.9% of all patients 1295, or 2.4% of those screened). Of 15 patients diagnosed with HIV during the TB episode, ten were enrolled in an HIV program. The median time between the result of the HIV screening and the first consultation at the HIV program was 82 days (IQR, 32-414). The median time between the result of the HIV screening and antiretroviral initiation was 148.5 days (IQR 32-500). Conclusions: An acceptable proportion of TB patients were screened for HIV in Lima. Referral systems of HIV positive patients should be strengthened for timely ART initiation

Prevalence, risk factors, and treatment outcomes of isoniazid- and rifampicin-mono-resistant pulmonary tuberculosis in Lima, Peru

Background : Isoniazid and rifampicin are the two most efficacious first-line agents for tuberculosis (TB) treatment. We assessed the prevalence of isoniazid and rifampicin mono-resistance, associated risk factors, and the association of mono-resistance on treatment outcomes. Methods : A prospective, observational cohort study enrolled adults with a first episode of smear-positive pulmonary TB from 34 health facilities in a northern district of Lima, Peru, from March 2010 through December 2011. Participants were interviewed and a sputum sample was cultured on Lowenstein-Jensen (LJ) media. Drug susceptibility testing was performed using the proportion method. Medication regimens were documented for each patient. Our primary outcomes were treatment outcome at the end of treatment. The secondary outcome included recurrent episodes among cured patients within two years after completion of the treatment. Results : Of 1292 patients enrolled, 1039 (80%) were culture-positive. From this subpopulation, isoniazid mono-resistance was present in 85 (8%) patients and rifampicin mono-resistance was present in 24 (2%) patients. In the multivariate logistic regression model, isoniazid mono-resistance was associated with illicit drug use (adjusted odds ratio (aOR) = 2.10; 95% confidence interval (CI): 1.1-4.1), and rifampicin mono-resistance was associated with HIV infection (aOR = 9.43; 95% CI: 1.9-47.8). Isoniazid mono-resistant patients had a higherrisk of poor treatment outcomes including treatment failure (2/85, 2%, p-value<0.01) and death (4/85, 5%, p<0.02). Rifampicin mono-resistant patients had a higher risk of death (2/24,8%, p<0.01). Conclusion : A high prevalence of isoniazid and rifampicin mono-resistance was found among TB patients in our low HIV burden setting which were similar to regions with high HIV burden. Patients with isoniazid and rifampicin mono-resistance had an increased risk of poor treatment outcomes

A prospective longitudinal study of tuberculosis among household contacts of smear-positive tuberculosis cases in Lima, Peru

Background: Household contacts (HHCs) of TB cases are at increased risk for TB disease compared to the general population but the risk may be modified by individual or household factors. We conducted a study to determine incident TB among HHCs over two years after exposure and to identify individual and household level risk factors. Methods: Adults newly diagnosed with a first episode of smear-positive pulmonary TB (index cases) between March 2010 and December 2011 in eastern Lima, were interviewed to identify their HHC and household characteristics. TB registers were reviewed for up to two years after the index case diagnosis and house visits were made to ascertain TB cases among HHC. The TB incidence rate ratio among HHCs as a function of risk factors was determined using generalized linear mixed models. Results: The 1178 index cases reported 5466 HHCs. In 402/1178 (34.1 %) households, at least one HHC had experienced a TB episode ever. The TB incidence among HHCs was 1918 (95% CI 1669-2194) per 100,000 person-years overall, and was 2392 (95% CI 2005-2833) and 1435 (95% CI 1139-1787) per 100,000 person-years in the first and second year, respectively. Incident TB occurred more than six months following the index case's TB diagnosis in 121/205 (59.0 %) HHCs. In HHCs, bacillary load and time between symptoms and treatment initiation in the index case, as well as the relationship to the index case and the sex of the HHC all had a significant association with TB incidence in HHCs. Conclusions: Incidence of TB among HHCs was more than ten times higher than in the general population. Certain HHC and households were at higher risk of TB, we recommend studies to compare HHC investigation to households at highest risk versus current practice, in terms of efficiency

Optical Communications Systems for NASA's Human Space Flight Missions

The Laser-Enhanced Mission Communications Navigation and Operational Services (LEMNOS) office at Goddard Space Flight Center (GSFC) manages two NASA optical communication related projects, the Orion EM-2 Optical Communications Terminal (O2O) and the Integrated Laser Communications Relay Demonstration (LCRD) Low-Earth Orbit (LEO) User Modem and Amplifier Terminal (ILLUMA-T) projects. The main goal of LEMNOS is the advancement and implementation of optical communications systems and technologies for NASA missions. The O2O mission is sponsored by NASA's Human Exploration and Operations (HEO) Mission Directorate. The O2O project will provide optical communications capability to the Orion series of spacecraft, starting with the demonstration of operational utility on EM-2. It will be the first time a human exploration mission will rely on optical communications for its high-bandwidth link. ILLUMA-T is sponsored by the Space Communications and Navigation (SCaN) Program Office. It is destined for the International Space Station (ISS) as an external payload attached to the Japanese Experiment Module - Exposed Facility (JEM-EF). The ILLUMA-T project is developing an optical communications user terminal to demonstrate high bandwidth data transfer between LEO and the ground through the geosynchronous LCRD relay. ILLUMA-T will be the first demonstration of a LEO user of the LCRD system, pointing and tracking from a moving spacecraft at LEO to GEO satellite and vice versa, end-to-end operational utility of optical communications, and 51 Mbps forward link to ISS from ground. Both projects are collaborations between GSFC, Massachusetts Institute of Technology " Lincoln Laboratory (MIT-LL), and a number of contractors

Optical Communication Activities Through the Laser-Enhanced Mission Communications Navigation and Operational Services (LEMNOS) Office

The Laser-Enhanced Mission Communications Navigation and Operational Services (LEMNOS) office at Goddard Space Flight Center (GSFC) manages two NASA optical communication related projects, the Orion EM-2 Optical Communications Terminal (O2O) and the Integrated Laser Communications Relay Demonstration (LCRD) Low-Earth Orbit (LEO) User Modem and Amplifier Terminal (ILLUMA-T) projects. The main goal of LEMNOS project is to implement optical communications technologies on NASA missions starting with demonstrations of operational utility on Orion EM-2 and the International Space Station

A Study of the Manufacture of Cultured Butter and Retail Store Sales in Brookings, South Dakota

Butter consumption in the united stated had dropped to 8.4 pounds per capita in 1953 from approximately 17 pounds prior to World War II. There has been only a very slight increase during the last five years. Dairy industry leaders and research workers have south to find the reason for this situation and possible remedies for it. A recent consumer preference study conducted by Rollag and Krist Janson (21) in Brookings and Sioux Falls, South Dakota indicated a fairly strong preference for high quality butter with a considerable amount of flavor obtained by adding butter culture to the butter. The present study is an attempt to determine consumer demand for high quality butter with culture flavor as measured by purchases from grocery stores in Brookings. It was a part of a cooperative research project between the Dairy Husbandry and Economics Departments of the South Dakota Agricultural Experiment Station

The long-term and interannual variability of summer fresh water storage over the eastern Siberian shelf: Implication for climatic change

A time series of summer fresh water content anomalies (FWCA) over the Laptev and East Siberian sea shelves was constructed from historical hydrographic records for the period from 1920 to 2005. Results from a multiple regression between FCWA and various atmospheric and oceanic indices show that the fresh water content on the shelves is mainly controlled by atmospheric vorticity on quasi-decadal timescales. When the vorticity of the atmosphere on the shelves is antycyclonic, approximately 500 km3 of fresh water migrates from the eastern Siberian shelf to the Arctic Ocean through the northeastern Laptev Sea. When the vorticity of the atmosphere is cyclonic, this fresh water remains on the southern Laptev and East Siberian sea shelves. This FWCA represents approximately 35% of the total fresh water inflow provided by river discharge and local sea-ice melt, and is about ten times larger than the standard deviation of the Lena River summer long-term mean discharge. However, the large interannual and spatial variability in the fresh water content of the shelves, as well as the spatial coverage of the hydrographic data, makes it difficult to detect the long-term tendency of fresh water storage associated with climate change

Sistematización del proceso participativo para la creación de la política de innovación en la UNED

Las universidades, como organizaciones sociales requieren transitar en un proceso de transformación que les permita repensar su quehacer y, alcanzar una mayor cercanía a las comunidades educativas, por medio del trabajo en sus áreas sustantivas. La innovación, se constituye en este contexto, en un acicate para la educación superior; que invoca cambio y transformación profunda en lo que hace y en las formas, procesos y herramientas que emplea para lograrlo. Esta concepción de innovación va más allá de lo que se considera en estos días y en diferentes contextos, reducida al uso intensivo de las tecnologías de la información y comunicación. La necesidad de sistematizar y generar conocimiento que permitiera comprender y fortalecer las capacidades innovadoras en la UNED, propició que un grupo interdisciplinario, conformado por decisión abierta e individual de sus integrantes y, con representación de las distintas Vicerrectorías de la universidad, se organizara y conformara el Nodo de Innovación. Este grupo asumió la tarea de investigar el quehacer innovador de la institución y el estudio de distintos marcos de referencia teórico-conceptuales sobre la innovación y la organización para ofrecer a las autoridades universitarias y la comunidad educativa en general, un diseño de sistema de innovación particular orientado a la UNED; sustentado en la aprobación de una política institucional y su respectivo plan de implementación. Esta ponencia explica la sistematización diseñada especialmente por el Nodo de Innovación, en la definición de esa propuesta de la política de innovación como sistema y que desde el mes de julio del 2017, se encuentra en discusión dentro de dos comisiones del Consejo Universitario, con la intención de ser llevada y aprobada al seno del plenario de ese órgano político colegiado