Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries.

SETTING Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons. OBJECTIVE To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries. DESIGN We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs. RESULTS Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages. CONCLUSIONS Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

An Unscathed Past in the Face of Death: Mortality Salience Reduces Individuals’ Regrets

Folk wisdom and popular literature hold that, in the face of death, individuals tend to regret things in their lives that they have done or failed to do. Terror Management Theory (TMT), in contrast, allows for the prediction that individuals who are confronted with death try to minimize the experience of regret in order to retain a positive self-esteem. Three experiments put these competing perspectives to test. Drawing on TMT, we hypothesized and found that participants primed with their own death regret fewer things than control-group participants. This pattern of results cannot be attributed to differing types of regrets (Study 1). Furthermore, we provide evidence suggesting that the effect is not purely a product of cognitive mechanisms such as differing levels of construal (Study 2), cognitive contrast, or deficits (Study 3). Rather, the reported results are best explained in terms of a motivational coping mechanism: When death is salient, individuals strive to bolster as well as protect their self-esteem and accordingly try to minimize the experience of regret. The results add to our conceptual understanding of regret and TMT, and suggest that a multitude of lifestyle guidebooks need updating.

Ventricular prosthesis embolization during transapical aortic valve implantation: the role of transesophageal echocardiography in diagnosis and management

The authors present the case of an 81-year-old patient with severe aortic stenosis who experienced left ventricular embolization of an aortic bioprosthesis during transapical aortic valve implantation. The authors discuss reasons for prosthesis embolization and reinforce the attention to technical details and the widespread use of multimodality imaging techniques. In this context, transesophageal echocardiography appears indispensable in the detection and management of procedure-related complications.

Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common co-morbidities in patients with moderate-to-severe psoriasis

BACKGROUND Psoriatic arthritis (PsA) and co-morbidities of psoriasis represent a significant clinical and economic burden for patients with moderate-to-severe psoriasis. Often these co-morbidities may go unrecognized or undertreated. While published data are available on the incidence and impact of some of them, practical guidance for dermatologists on detection and management of these co-morbidities is lacking. OBJECTIVE To prepare expert recommendations to improve the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis. METHODS A systematic literature review was conducted on some common co-morbidities of psoriasis-cardiovascular (CV) diseases (including obesity, hypertension, hyperglycaemia and dyslipidaemia), psychological co-morbidities (including depression, alcohol abuse and smoking) and PsA-to establish the incidence and impact of each. Data gaps were identified and a Delphi survey was carried out to obtain consensus on the detection and management of each co-morbidity. The expert panel members for the Delphi survey comprised 10 dermatologists with substantial clinical expertise in managing moderate-to-severe psoriasis patients, as well as a cardiologist and a psychologist (see appendix) with an interest in dermatology. Agreement was defined using a Likert scale of 1-7. Consensus regarding agreement for each statement was defined as ≥75% of respondents scoring either 1 (strongly agree) or 2 (agree). RESULTS The expert panel members addressed several topics including screening, intervention, monitoring frequency, and the effects of anti-psoriatic treatment on each co-morbidity. Consensus was achieved on 12 statements out of 22 (3 relating to PsA, 4 relating to psychological factors, 5 relating to CV factors). The panel members felt that dermatologists have an important role in screening their psoriasis patients for PsA and in assessing them for psychological and CV co-morbidities. In most cases, however, patients should be referred for specialist management if other co-morbidities are detected. CONCLUSION This article provides useful and practical guidance for the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis.

A Matter of Perspective? Disentangling the Emic−Etic Debate in the Scientific Study of Religion\s

This article introduces the emic–etic debate in the scientific study of religion\s and provides a frame for the special issue’s six articles on the topic. Departing from the broader debate’s early history in the 1960s, this article contextualizes the emic–etic debate and locates its point of entry into the scientific study of religion\s in the 1980s. This article argues that in the course of the debate the insider–outsider and emic–etic complexes have become entangled. In order to facilitate an understanding of the debate, this article maintains that the emic–etic debate in the scientific study of religion\s touches upon three central dimensions (existential–political, methodologi- cal, and epistemological). In order to move toward a clearer methodological and epis- temological framework, this article furthermore proposes an iterative model that locates insider–outsider at the level of observers and emic–etic at the level of categories.

Efficient Deployment of Mobile Detectors for Security Applications

We present a real-world problem that arises in security threat detection applications. The problem consists of deploying mobile detectors on moving units that follow predefined routes. Examples of such units are buses, coaches, and trolleys. Due to a limited budget not all available units can be equipped with a detector. The goal is to equip a subset of units such that the utility of the resulting coverage is maximized. Existing methods for detector deployment are designed to place detectors in fixed locations and are therefore not applicable to the problem considered here. We formulate the planning problem as a binary linear program and present a coverage heuristic for generating effective deployments in short CPU time. The heuristic has theoretical performance guarantees for important special cases of the problem. The effectiveness of the coverage heuristic is demonstrated in a computational analysis based on 28 instances that we derived from real-world data.