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The impact of implementing a Xpert MTB/RIF algorithm on drug-sensitive pulmonary tuberculosis: a retrospective analysis
- K. REES, N. MUDITAMBI, M. MASWANGANYI, J. RAILTON, J. A. MCINTYRE, H. E. STRUTHERS, P. B. FOURIE, R. P. H. PETERS
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- Journal:
- Epidemiology & Infection / Volume 146 / Issue 2 / January 2018
- Published online by Cambridge University Press:
- 06 December 2017, pp. 246-255
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Xpert MTB/RIF (Xpert) is the preferred first-line test for all persons with tuberculosis (TB) symptoms in South Africa in line with a diagnostic algorithm. This study evaluates pre- and post-implementation trends in diagnostic practices for drug-sensitive, pulmonary TB in adults in an operational setting, following the introduction of the Xpert-based algorithm. We retrospectively analysed data from the national TB database for Greater Tzaneen sub-district, Limpopo Province. Trends in a number of cases, diagnosis and outcome and characteristics associated with death are reported. A total of 8407 cases were treated from 2008 until 2015, with annual cases registered decreasing by 31·7% over that time period (from 1251 to 855 per year). After implementation of Xpert, 69·9% of cases were diagnosed by Xpert, 29·4% clinically, 0·6% by smear microscopy and 0·1% by culture. Cases with a recorded microbiological test increased from 76·2% to 96·4%. Cases started on treatment without confirmation, but with a negative microbiological test increased from 7·1% to 25·7%. Case fatality decreased from 15·0% to 9·8%, remaining consistently higher in empirically treated groups, regardless of HIV status. Implementation of the algorithm coincided with a reduced number of TB cases treated and improved coverage of microbiological testing; however, a substantial proportion of cases continued to start treatment empirically.
The Last Interglacial Ocean
- Rose Marie L. Cline, James D. Hays, Warren L. Prell, William F. Ruddiman, Ted C. Moore, Nilva G. Kipp, Barbara E. Molfino, George H. Denton, Terence J. Hughes, William L. Balsam, Charlotte A. Brunner, Jean-Claude Duplessy, Ann G. Esmay, James L. Fastook, John Imbrie, Lloyd D. Keigwin, Thomas B. Kellogg, Andrew McIntyre, Robley K. Matthews, Alan C. Mix, Joseph J. Morley, Nicholas J. Shackleton, S. Stephen Streeter, Peter R. Thompson
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- Journal:
- Quaternary Research / Volume 21 / Issue 2 / February 1984
- Published online by Cambridge University Press:
- 20 January 2017, pp. 123-224
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The final effort of the CLIMAP project was a study of the last interglaciation, a time of minimum ice volume some 122,000 yr ago coincident with the Substage 5e oxygen isotopic minimum. Based on detailed oxygen isotope analyses and biotic census counts in 52 cores across the world ocean, last interglacial sea-surface temperatures (SST) were compared with those today. There are small SST departures in the mid-latitude North Atlantic (warmer) and the Gulf of Mexico (cooler). The eastern boundary currents of the South Atlantic and Pacific oceans are marked by large SST anomalies in individual cores, but their interpretations are precluded by no-analog problems and by discordancies among estimates from different biotic groups. In general, the last interglacial ocean was not significantly different from the modern ocean. The relative sequencing of ice decay versus oceanic warming on the Stage 6/5 oxygen isotopic transition and of ice growth versus oceanic cooling on the Stage 5e/5d transition was also studied. In most of the Southern Hemisphere, the oceanic response marked by the biotic census counts preceded (led) the global ice-volume response marked by the oxygen-isotope signal by several thousand years. The reverse pattern is evident in the North Atlantic Ocean and the Gulf of Mexico, where the oceanic response lagged that of global ice volume by several thousand years. As a result, the very warm temperatures associated with the last interglaciation were regionally diachronous by several thousand years. These regional lead-lag relationships agree with those observed on other transitions and in long-term phase relationships; they cannot be explained simply as artifacts of bioturbational translations of the original signals.
A 10-year cohort analysis of routine paediatric ART data in a rural South African setting
- R. R. LILIAN, B. MUTASA, J. RAILTON, W. MONGWE, J. A. McINTYRE, H. E. STRUTHERS, R. P. H. PETERS
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- Journal:
- Epidemiology & Infection / Volume 145 / Issue 1 / January 2017
- Published online by Cambridge University Press:
- 09 September 2016, pp. 170-180
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South Africa's paediatric antiretroviral therapy (ART) programme is managed using a monitoring and evaluation tool known as TIER.Net. This electronic system has several advantages over paper-based systems, allowing profiling of the paediatric ART programme over time. We analysed anonymized TIER.Net data for HIV-infected children aged <15 years who had initiated ART in a rural district of South Africa between 2005 and 2014. We performed Kaplan–Meier survival analysis to assess outcomes over time. Records of 5461 children were available for analysis; 3593 (66%) children were retained in care. Losses from the programme were higher in children initiated on treatment in more recent years (P < 0·0001) and in children aged ≤1 year at treatment initiation (P < 0·0001). For children aged <3 years, abacavir was associated with a significantly higher rate of loss from the programme compared to stavudine (hazard ratio 1·9, P < 0·001). Viral load was suppressed in 48–52% of the cohort, with no significant change over the years (P = 0·398). Analysis of TIER.Net data over time provides enhanced insights into the performance of the paediatric ART programme and highlights interventions to improve programme performance.
Mutual dilution of infection by an introduced parasite in native and invasive stream fishes across Hawaii
- RODERICK B. GAGNE, DAVID C. HEINS, PETER B. MCINTYRE, JAMES F. GILLIAM, MICHAEL J. BLUM
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- Journal:
- Parasitology / Volume 143 / Issue 12 / October 2016
- Published online by Cambridge University Press:
- 11 July 2016, pp. 1605-1614
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The presence of introduced hosts can increase or decrease infections of co-introduced parasites in native species of conservation concern. In this study, we compared parasite abundance, intensity, and prevalence between native Awaous stamineus and introduced poeciliid fishes by a co-introduced nematode parasite (Camallanus cotti) in 42 watersheds across the Hawaiian Islands. We found that parasite abundance, intensity and prevalence were greater in native than introduced hosts. Parasite abundance, intensity and prevalence within A. stamineus varied between years, which largely reflected a transient spike in infection in three remote watersheds on Molokai. At each site we measured host factors (length, density of native host, density of introduced host) and environmental factors (per cent agricultural and urban land use, water chemistry, watershed area and precipitation) hypothesized to influence C. cotti abundance, intensity and prevalence. Factors associated with parasitism differed between native and introduced hosts. Notably, parasitism of native hosts was higher in streams with lower water quality, whereas parasitism of introduced hosts was lower in streams with lower water quality. We also found that parasite burdens were lower in both native and introduced hosts when coincident. Evidence of a mutual dilution effect indicates that introduced hosts can ameliorate parasitism of native fishes by co-introduced parasites, which raises questions about the value of remediation actions, such as the removal of introduced hosts, in stemming the rise of infectious disease in species of conservation concern.
11 - Conservation of migratory fishes in freshwater ecosystems
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- By Peter B. McIntyre, University of Wisconsin, Catherine Reidy Liermann, University of Wisconsin, Evan Childress, University of Wisconsin, Ellen J. Hamann, University of Wisconsin, J. Derek Hogan, Texas A&M University – Corpus Christi, Stephanie R. Januchowski-Hartley, Texas A&M University – Corpus Christi, Aaron A. Koning, University of Wisconsin, Thomas M. Neeson, University of Wisconsin, Daniel L. Oele, University of Wisconsin, Brenda M. Pracheil, Oak Ridge National Laboratory
- Edited by Gerard P. Closs, University of Otago, New Zealand, Martin Krkosek, University of Toronto, Julian D. Olden, University of Washington
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- Book:
- Conservation of Freshwater Fishes
- Published online:
- 05 December 2015
- Print publication:
- 03 December 2015, pp 324-360
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Summary
Migratory fishes are natural wonders. For many people, the term migratory fish evokes images of salmon audaciously jumping at waterfalls as they return to their own riverine birthplace to spawn after years of growth in the ocean, but freshwater fishes actually show a broad spectrum of migration strategies. Migratory fishes include small species – three-spined sticklebacks that spawn in coastal streams around the northern Pacific and gobies that move from the ocean into tropical island streams by climbing waterfalls (McDowall, 1988) – as well as some of the largest freshwater fishes in the world, such as the Mekong dog-eating catfish and the Chinese paddlefish (Stone, 2007). Aside from migratory habits, these species have few shared characteristics; they encompass numerous evolutionary lineages, enormous differences in life history, and every possible direction and distance of migration. Biologists treat migratory freshwater fishes as a functional group because their life-history strategy revolves around long-distance movement between ecosystems in a perilous quest to take advantage of both high-quality breeding sites and bountiful feeding areas. As humans have physically blocked fish migrations, degraded breeding and feeding grounds and relentlessly harvested migrants for their flesh and roe, many populations have declined or been extirpated. This chapter will provide an overview of fundamental and applied research that is helping to guide efforts to conserve migratory freshwater fishes.
For practical purposes, we define migratory behaviour as the synchronized movement of a substantial proportion of a population between distinct habitats, which is repeated through time within or across generations. Modern definitions of fish migrations typically recognise both the adaptive benefits of migrating and individual variation in executing the general strategy (see McDowall, 1988; Lucas & Baras, 2001). Not every individual must move, the timing may vary somewhat from year to year, and the motive for migrating may include seeking refuge from harsh conditions in addition to breeding and feeding. Nonetheless, in most cases, migration is critical to individual fitness and population persistence because it enables specialised use of different habitats for growth and reproduction. Where their migration routes are blocked or key habitats are lost, migratory fishes often suffer rapid and catastrophic losses.
Human appropriation and degradation of the Earth's freshwater ecosystems (Vörösmarty et al., 2010; Carpenter et al., 2011) have transformed this reliance on multiple habitats into a detriment for many migratory fishes.
Population-Based Study of Pseudoprogression after Chemoradiotherapy in GBM
- Gloria B. Roldán, James N. Scott, John B. McIntyre, Marisa Dharmawardene, Paula A. de Robles, Anthony M. Magliocco, Elizabeth S. Y. Yan, Ian F. Parney, Peter A. Forsyth, J. Gregory Cairncross, Mark G. Hamilton, Jacob C. Easaw
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 36 / Issue 5 / September 2009
- Published online by Cambridge University Press:
- 02 December 2014, pp. 617-622
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Introduction:
Chemoradiotherapy followed by monthly temozolomide (TMZ) is the standard of care for patients with glioblastoma multiforme (GBM). Case reports have identified GBM patients who experienced transient radiological deterioration after concurrent chemoradiotherapy which stabilized or resolved after additional cycles of adjuvant TMZ, a phenomenon known as radiographic pseudoprogression. Little is known about the natural history of radiographic pseudoprogression.
Methods:We retrospectively evaluated the incidence of radiographic pseudoprogression in a population-based cohort of GBM patients and determined its relationship with outcome and MGMT promoter methylation status.
Results:Out of 43 evaluable patients, 25 (58%) exhibited radiographic progression on the first MRI after concurrent treatment. Twenty of these went on to receive adjuvant TMZ, and subsequent investigation demonstrated radiographic pseudoprogression in 10 cases (50%). Median survival (MS) was better in patients with pseudoprogression (MS 14.5 months) compared to those with true radiologic progression (MS 9.1 months, p=0.025). The MS of patients with pseudoprogression was similar to those who stabilized/responded during concurrent treatment (p=0.31). Neither the extent of the initial resection nor dexamethasone dosing was associated with pseudoprogression.
Conclusions:These data suggest that physicians should continue adjuvant TMZ in GBM patients when early MRI scans show evidence of progression following concurrent chemoradiotherapy, as up to 50% of these patients will experience radiologic stability or improvement in subsequent treatment cycles.
Contributors
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- By Ghazi Al-Rawas, Vazken Andréassian, Tianqi Ao, Stacey A. Archfield, Berit Arheimer, András Bárdossy, Trent Biggs, Günter Blöschl, Theresa Blume, Marco Borga, Helge Bormann, Gianluca Botter, Tom Brown, Donald H. Burn, Sean K. Carey, Attilio Castellarin, Francis Chiew, François Colin, Paulin Coulibaly, Armand Crabit, Barry Croke, Siegfried Demuth, Qingyun Duan, Giuliano Di Baldassarre, Thomas Dunne, Ying Fan, Xing Fang, Boris Gartsman, Alexander Gelfan, Mikhail Georgievski, Nick van de Giesen, David C. Goodrich, Hoshin V. Gupta, Khaled Haddad, David M. Hannah, H. A. P. Hapuarachchi, Hege Hisdal, Kamila Hlavčová, Markus Hrachowitz, Denis A. Hughes, Günter Humer, Ruud Hurkmans, Vito Iacobellis, Elena Ilyichyova, Hiroshi Ishidaira, Graham Jewitt, Shaofeng Jia, Jeffrey R. Kennedy, Anthony S. Kiem, Robert Kirnbauer, Thomas R. Kjeldsen, Jürgen Komma, Leonid M. Korytny, Charles N. Kroll, George Kuczera, Gregor Laaha, Henny A. J. van Lanen, Hjalmar Laudon, Jens Liebe, Shijun Lin, Göran Lindström, Suxia Liu, Jun Magome, Danny G. Marks, Dominic Mazvimavi, Jeffrey J. McDonnell, Brian L. McGlynn, Kevin J. McGuire, Neil McIntyre, Thomas A. McMahon, Ralf Merz, Robert A. Metcalfe, Alberto Montanari, David Morris, Roger Moussa, Lakshman Nandagiri, Thomas Nester, Taha B. M. J. Ouarda, Ludovic Oudin, Juraj Parajka, Charles S. Pearson, Murray C. Peel, Charles Perrin, John W. Pomeroy, David A. Post, Ataur Rahman, Liliang Ren, Magdalena Rogger, Dan Rosbjerg, José Luis Salinas, Jos Samuel, Eric Sauquet, Hubert H. G. Savenije, Takahiro Sayama, John C. Schaake, Kevin Shook, Murugesu Sivapalan, Jon Olav Skøien, Chris Soulsby, Christopher Spence, R. ‘Sri’ Srikanthan, Tammo S. Steenhuis, Jan Szolgay, Yasuto Tachikawa, Kuniyoshi Takeuchi, Lena M. Tallaksen, Dörthe Tetzlaff, Sally E. Thompson, Elena Toth, Peter A. Troch, Remko Uijlenhoet, Carl L. Unkrich, Alberto Viglione, Neil R. Viney, Richard M. Vogel, Thorsten Wagener, M. Todd Walter, Guoqiang Wang, Markus Weiler, Rolf Weingartner, Erwin Weinmann, Hessel Winsemius, Ross A. Woods, Dawen Yang, Chihiro Yoshimura, Andy Young, Gordon Young, Erwin Zehe, Yongqiang Zhang, Maichun C. Zhou
- Edited by Günter Blöschl, Technische Universität Wien, Austria, Murugesu Sivapalan, University of Illinois, Urbana-Champaign, Thorsten Wagener, University of Bristol, Alberto Viglione, Technische Universität Wien, Austria, Hubert Savenije, Technische Universiteit Delft, The Netherlands
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- Runoff Prediction in Ungauged Basins
- Published online:
- 05 April 2013
- Print publication:
- 18 April 2013, pp ix-xiv
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Interactions Between Carbon Nanotubes and Liquid Crystals in Binary Nematic Electro-Optic Cells
- Georgi Yordanov Georgiev, Erin A Gombos, Michael B McIntyre, Michael F Mattera, Peter A. Gati, Yaniel Cabrera, Peggy Cebe
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1228 / 2009
- Published online by Cambridge University Press:
- 31 January 2011, 1228-KK11-81
- Print publication:
- 2009
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We studied the effects of multiwalled carbon nanotubes (MWCNTs) on the Freedericksz transition of a liquid crystal (LC) and calibrated the altitudinal angle of CNTs as a function of the electric field. In addition, we directed the azimuthal angle which gave us complete control of the 3D orientation of the CNTs. We constructed anti-parallel electro-optic cells using a nanocomposite at a concentration of 0.01% CNTs with 4-Cyano-4'-pentylbiphenyl (5CB) liquid crystal. This low concentration was necessary to achieve maximum transmission of electromagnetic radiation through the cell and to minimize the Van der Waals attraction between the CNTs responsible for their aggregation. We chose two dimensional microscopic transmission ellipsometry (2D-MTE) to measure the phaseshift of the polarized electromagnetic radiation through the cell and to derive from it the altitudinal angle of the CNTs. Our results show that in the presence of CNTs the Freedericksz transition occurs at 55% of the transitional electric field as compared to the control electro-optic cell without CNTs. The width of the Freedericksz transition narrows by a similar factor. The switching time of the cell decreased in the presence CNTs by 18.5%.