Tuberculosis in HIV programmes in lower-income countries: practices and risk factors

BACKGROUND: Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART). OBJECTIVE: To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART. METHODS: Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models. RESULTS: Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥16 years contributed 13 227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33–0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68–0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19–0.31, P < 0.0001). CONCLUSIONS: Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.

Prevalence and predictors of kaposi sarcoma herpes virus seropositivity: a cross-sectional analysis of HIV-infected adults initiating ART in Johannesburg, South Africa

Background Kaposi sarcoma (KS) is the most common AIDS-defining tumour in HIV-infected individuals in Africa. Kaposi sarcoma herpes virus (KSHV) infection precedes development of KS. KSHV co-infection may be associated with worse outcomes in HIV disease and elevated KSHV viral load may be an early marker for advanced HIV disease among untreated patients. We examined the prevalence of KSHV among adults initiating antiretroviral therapy (ART) and compared immunological, demographic and clinical factors between patients seropositive and seronegative for KSHV. Results We analyzed cross-sectional data collected from 404 HIV-infected treatment-naïve adults initiating ART at the Themba Lethu Clinic, Johannesburg, South Africa between November 2008 and March 2009. Subjects were screened at ART initiation for antibodies to KSHV lytic K8.1 and latent Orf73 antigens. Seropositivity to KSHV was defined as positive to either lytic KSHV K8.1 or latent KSHV Orf73 antibodies. KSHV viremia was determined by quantitative PCR and CD3, 4 and 8 lymphocyte counts were determined with flow cytometry. Of the 404 participants, 193 (48%) tested positive for KSHV at ART initiation; with 76 (39%) reactive to lytic K8.1, 35 (18%) to latent Orf73 and 82 (42%) to both. One individual presented with clinical KS at ART initiation. The KSHV infected group was similar to those without KSHV in terms of age, race, gender, ethnicity, smoking and alcohol use. KSHV infected individuals presented with slightly higher median CD3 (817 vs. 726 cells/mm3) and CD4 (90 vs. 80 cells/mm3) counts than KSHV negative subjects. We found no associations between KSHV seropositivity and body mass index, tuberculosis status, WHO stage, HIV RNA levels, full blood count or liver function tests at initiation. Those with detectable KSHV viremia (n = 19), however, appeared to present with signs of more advanced HIV disease including anemia and WHO stage 3 or 4 defining conditions compared to those in whom the virus was undetectable. Conclusions We demonstrate a high prevalence of KSHV among HIV-infected adults initiating ART in a large urban public-sector HIV clinic. KSHV viremia but not KSHV seropositivity may be associated with markers of advanced HIV disease.

The Beach in Anglophone Literatures and Cultures: Reading Littoral Space

From early colonial encounters to the ecological disasters of the twenty-first century, the performativity of contact has been a crucial element in the political significance of the beach. Conceptualising the beach as a creative trope and as a socio-cultural site, as well as an aesthetically productive topography, this collection examines its multiplicity of meanings and functions as a natural environment engendering both desire and fear in the human imagination from the Victorian period to the present. The contributors examine literature, film, and art, in addition to moments of encounter and environmental crisis, to highlight the beach as a social space inspiring particular codes of behaviour and specific discourses, as a geographical frontier between land and water, as an historical site of contact and conflict, and as a vacationscape promising regeneration and withdrawal from everyday life. The diversity of the beach is reflected in the geographical range, with essays on locales and texts from Britain, Ireland, the Caribbean, South Africa, the United States, Polynesia, and New Zealand. Focusing on the changed function of the beach as a result of processes of industrialisation and the rise of a modern leisure and health culture, this interdisciplinary volume theorises the beach as a demarcater of the precarious boundary between land and the sea, as well as between nature and culture.

Cross-culture perspectives on fear of HIV disease and AIDS in health care workers

Health care workers have been known to carry into the workplace a variety of judgmental and negative attitudes towards their patients. In no other area of patient care has this issue been more pronounced as in the management of patients with AIDS. Health care workers have refused to treat or manage patients with AIDS and have often treated them more harshly than identically described leukemia patients. Some health care institutions have simply refused to admit patients with AIDS and even recent applicants to medical colleges and schools of nursing have indicated a preference for schools in areas with low prevalence of HIV disease. Since the attitudes of health care workers do have significant consequences on patient management, this study was carried out to determine the differences in clinical practice in Nigeria and the United States of America as it relates to knowledge of a patient's HIV status, determine HIV prevalence and culture in each of the study sites and how they impact on infection control practices, determine the relationship between infection control practices and fear of AIDS, and also determine the predictors of safe infection control practices in each of the study sites.^ The study utilized the 38-item fear of AIDS scale and the measure of infection control questionnaire for its data. Questionnaires were administered to health care workers at the university teaching hospital sites of Houston, Texas and Calabar in Nigeria. Data was analyzed using a chi-square test, and where appropriate, a student t-tests to establish the demographic variables for each country. Factor analysis was done using principal components analysis followed by varimax rotation to simple structure. The subscale scores for each study site were compared using t-tests (separate variance estimates) and utilizing Bonferroni adjustments for number of tests. Finally, correlations were carried out between infection control procedures and fear of AIDS in each study site using Pearson-product moment correlation coefficients.^ The study revealed that there were five dimensions of the fear of AIDS in health care workers, namely fear of loss of control, fear of sex, fear of HIV infection through blood and illness, fear of death and medical interventions and fear of contact with out-groups. Fear of loss of control was the primary area of concern in the Nigerian health care workers whereas fear of HIV infection through blood and illness was the most important area of AIDS related feats in United States health care workers. The study also revealed that infection control precautions and practices in Nigeria were based more on normative and social pressures whereas it was based on knowledge of disease transmission, supervision and employee discipline in the United States, and thus stresses the need for focused educational programs in health care settings that emphasize universal precautions at all times and that are sensitive to the cultural nuances of that particular environment. ^

The Islamic Crossed-Arch Domes in Cordoba: Geometry and Structural Analysis of the “Capilla de Villaviciosa”

Crossed-arch domes are a singular type of ribbed vaults. Their characteristic feature is that the ribs that form the vault are intertwined, forming polygons or stars, leaving an empty space in the centre. The earliest known vaults of this type are found in the Great Mosque of Córdoba, built ca. 960 a.C. The type spread through Spain, and the north of Africa in the 10th to the 16th Centuries, and was used by Guarini and Vittone in the 17th and 18th Centuries in Italy. However, it was used only in a few buildings. Though the literature about the structural behaviour of ribbed Gothic vaults is extensive, so far no structural analysis of crossed arch domes has been made. The purpose of this work is, first to show the way to attack such an analysis within the frame of Modern Limit Analysis of Masonry Structures (Heyman 1995), and then to apply the approach to study the stability of the dome of the Capilla de Villaviciosa. The work may give some clues to art and architectural historians to understand better the origin and development of Islamic dome architecture.

The Interior City Infinity and Concavity in the No-Stop City (1970-1971)

In the late 60s it had become clear how the environment technification had allowed some typologies (supermarkets, car parks, factories) to reach potentially unlimited built depths becoming, therefore, independent from the outside. The No-Stop City is born from a very simple idea: to extend this technification to the totality of built reality encompassing, not only almost all functions, but ultimately, the whole city. This operation has paradoxical effects: as architecture grows, it loses most of the features that have traditionally defined it. A dissolution by hypertrophy that gives rise to an homogeneous, concave and potentially infinite space. But beyond the pure technical feasibility, there are two key influences, seemingly contradictory, that explain this endeavor for an interior and endless city: Marxism and Pop Art. The project is, in many senses, a built manifesto reflecting the militancy of the group members within the Italian Marxism. But it is also the embodiment of the groups declared interest in Pop Art, popular culture and mass society. The cross-influence of communism and consumerism explains this "quantitative utopia" in which the society and the factory, the production and consumption, would match. A city based on the centrality of consumer products and the subsequent loss of prominence of architecture, in which the urban phenomenon, while spreading endlessly over territory, ignoring its rural exteriority, dissolves the home as a sphere of privacy, ignoring its domestic interiority. A project, also in the wake of Marshall McLuhan, that illustrates like few others the conversion of the urbane into a virtually omnipresent "condition" and that still interrogates us with questions that are, on the other hand, eternal: What is a building? What is a city?

"Another Way": The Pneumatology of Deleuzean Minoritarian Communal Interpretation in Scripture, the 16th Century Radical Reformation, and Alternative 21st Century Anabaptist Community

This dissertation proposes a constructive theology of the Holy Spirit called the "pneumatology of minoritarian communal interpretation," the alternative creation of meaning within an oppressive majority context. It illustrates the convergence of Deleuzean philosophy with Anabaptist pneumatology and media communal interpretation theory in three particular locations: 1) selected mentions of the Holy Spirit in the Hebrew Bible and Christian New Testament; 2) the 16th century Radical Reformation; and 3) "Another Way," a 21st century alternative Anabaptist group focused around the spiritual discussion of art and popular media. Chapter One outlines the three theories. Chapter Two examines the Holy Spirit in the Hebrew Bible, particularly 1 Samuel 8, the book of Ezekiel, and the Gospel narratives. Chapter Three examines the pneumatological writings of the Radical Reformers, concentrating particularly on their theologies of the intersection between church and the surrounding majoritarian culture. Chapter Four outlines my original field research with Another Way, and examines the tension between minoritarian communal interpretation and the 21st century semiotic regime. Chapter Five then summarizes the conversations between theory and illustration to propose the pneumatology of minoritarian communal interpretation for Christian theology.

Creating Beautiful Art: Challenging Comfort

Creating Beautiful Art: Challenging Comfort investigates the notion of beauty and its relationship to art while asking what is and can be art. Throughout the work, research supports the concept of beauty elevating art even with the use of atypical, unconventional, or mundane materials. Direct attention is given to this idea by completion of a Creative Capstone Project. I incorporated aesthetics with unconventional materials in order to challenge viewing comfort, as well as added value to the existing body of knowledge concerning beauty in contemporary art. The reflective section summarizes the importance of unconventional materials creating beauty in art in order to progress itself linearly by creating and reinventing the new.

On Becoming a Working Visual Artist: Opportunities and Challenges Along the Path

Thousands of students graduate from colleges and art schools every year with the goal of becoming working visual artists. The majority of them, however, find that earning a living as a working artist is a tough and competitive career path. This Capstone Project, through an extensive literature review and interviews, examines the factors and characteristics that influence whether an individual will make the leap to becoming a working visual artist. Research results indicate that primary factors in achieving the status of working visual artists include specific personality traits, experiential and career-oriented arts education, and development of strong business skills.

How Competition Over Limited Natural Resources Impacts the Formation of Culture

This project analyzes the closely linked connection between the competition over limited resources and the formation of culture as it pertains to art and literature. The project is broken into three main topics: the influence of limited resources on competition, the role that competition and other factors have on the formation of culture, and finally how art and literature are reflective of resources, the competition for those resources, and other historical influences. This paper concludes that while there are many factors in the creation of cultures, competition over limited natural resources plays the most integral role in the formation of culture.

Culture conflict and crime,

Mode of access: Internet.

The complete dictionary of arts and sciences. In which the whole circle of human learning is explained, and the difficulties attending the acquisition of every art, whether liberal or mechanical, are removed, in the most easy and familiar manner ... /

Mode of access: Internet.

The complete dictionary of arts and sciences. In which the whole circle of human learning is explained, and the difficulties attending the acquisition of every art, whether liberal or mechanical, are removed, in the most easy and familiar manner ... /

Mode of access: Internet.