Tuberculosis in Cape Town: An age-structured transmission model.

BACKGROUND Tuberculosis (TB) is the leading cause of death in South Africa. The burden of disease varies by age, with peaks in TB notification rates in the HIV-negative population at ages 0-5, 20-24, and 45-49 years. There is little variation between age groups in the rates in the HIV-positive population. The drivers of this age pattern remain unknown. METHODS We developed an age-structured simulation model of Mycobacterium tuberculosis (Mtb) transmission in Cape Town, South Africa. We considered five states of TB progression: susceptible, infected (latent TB), active TB, treated TB, and treatment default. Latently infected individuals could be re-infected; a previous Mtb infection slowed progression to active disease. We further considered three states of HIV progression: HIV negative, HIV positive, on antiretroviral therapy. To parameterize the model, we analysed treatment outcomes from the Cape Town electronic TB register, social mixing patterns from a Cape Town community and used literature estimates for other parameters. To investigate the main drivers behind the age patterns, we conducted sensitivity analyses on all parameters related to the age structure. RESULTS The model replicated the age patterns in HIV-negative TB notification rates of Cape Town in 2009. Simulated TB notification rate in HIV-negative patients was 1000/100,000 person-years (pyrs) in children aged <5 years and decreased to 51/100,000 in children 5-15 years. The peak in early adulthood occurred at 25-29 years (463/100,000 pyrs). After a subsequent decline, simulated TB notification rates gradually increased from the age of 30 years. Sensitivity analyses showed that the dip after the early adult peak was due to the protective effect of latent TB and that retreatment TB was mainly responsible for the rise in TB notification rates from the age of 30 years. CONCLUSION The protective effect of a first latent infection on subsequent infections and the faster progression in previously treated patients are the key determinants of the age-structure of TB notification rates in Cape Town.

Special Tax Treatment as Trade Policy: A Database on Export Processing and Special Economic Zones

Many countries treat income generated via exports favourably, especially when production takes places in special zones known as export processing zones (EPZs). EPZs can be defined as specific, geographically defined zones or areas that are subject to special administration and that generally offer tax incentives, such as duty‐free imports when producing for export, exemption from other regulatory constraints linked to import for the domestic market, sometimes favourable treatment in terms of industrial regulation, and the streamlining of border clearing procedures. We describe a database of WTO Members that employ special economic zones as part of their industrial policy mix. This is based on WTO notification and monitoring through the WTO’s trade policy review mechanism (TPRM), supplemented with information from the ILO, World Bank, and primary sources. We also provide some rough analysis of the relationship between use of EPZs and the carbon intensity of exports, and relative levels of investment across countries with and without special zones.

The Impact of the IRS Retirement Option Relative Value

This study evaluates the effects of the new Government regulations in regards to the relative value notification of retirement plan options. It looks at how these new regulations will affect retirement plan option utilization and how retirement plan providers will change options in order to minimize risk.

Lease Defaults and the Efficient Mitigation of Damages

The traditional law of leases imposed no duty on landlords to mitigate damages in the event of tenant breach, whereas the modern law of leases does. An economic model of leases, in which absentee tenants may or may not intend to breach, shows that the traditional rule promotes tenant investment in the property by discouraging landlord entry. In contrast, the modern rule prevents the property from being left idle by encouraging landlords to enter and re-let abandoned property. The model reflects the historic use of the traditional rule for agricultural leases, where absentee use was valuable, and the emergence of the modern rule for residential leases, where the primary use entails continuous occupation.

The care to share HIV disclosure study - the attitudes toward and beliefs about HIV disclosure among perinatally-infected HIV-positive youth and their caregivers

HIV incidence has not changed since the introduction of the pandemic. Daily 14,000 persons are infected with HIV and 25 to 50% of the HIV-infected population and subgroups respectively are estimated to be unaware of their HIV diagnosis. Perinatally-infected HIV-positive youth, aged 13-24 years, have survived unexpectedly into adulthood, have had unique HIV disclosure experiences and now face HIV disclosure issues of adulthood and perhaps parenthood. Despite new effective HIV therapies, no HIV prevention plan exists that has diminished the rate of new HIV infections. HIV stigma and lack of universal HIV reporting laws dissuade timely HIV disclosure. Missed HIV disclosure perpetuates HIV transmission and infection. Understanding the attitudes and beliefs of HIV disclosure among perinatally-infected HIV-positive youth and their caregivers may uncover reasons to HIV disclosure delays, avoidance and intentions. The Care to Share HIV Disclosure study was designed to identify the attitudes and beliefs of HIV disclosure among HIV-positve youth (aged 13-24 years), who were infected from birth and who knew their HIV diagnosis, along with their caregivers. Twenty-six participants (15 youth and 11 caregivers) completed the theory-based questionnaires of a 21-item multiple choice survey on HIV disclosure framed in the Theory of Reasoned Action and Theory of Planned Behavior and included an additional open-ended survey that applied the Transactional Model of Stress and Coping to address youth's and caregivers' HIV disclosure experiences. Youth were found to have a selective unfavorable HIV disclosure outcome when among referents of close friends. However youth did believe in HIV partner notification. For caregivers, it mattered who disclosed the HIV illness to the youth. HIV stigma was of concern based on the youths' tendency to believe in keeping HIV a secret and their caregivers' ambivalence to HIV secrecy. However, favorable HIV disclosure outcomes were identified for both youth and caregivers the potential for HIV disclosure: when seeking HIV knowledge, when around caregivers and close family and in situations of perceived controllability as when helping others learn about HIV. These findings unveil HIV disclosure attitudes and beliefs within this population and may reveal the attributes that may inhibit or promote HIV disclosure behaviors. HIV disclosure studies that address attitudes and beliefs among larger populations of youth and HIV-infected persons are necessary to identify effective individual, group and society approaches that would promote timely, responsible and meaningful HIV disclosure methods that promote a healthy identity and interrupt HIV transmission.^

Impact of real time polymerase chain reaction technology on the therapeutic approach to treatment of staphylococcal infections

Can the early identification of the species of staphylococcus responsible for infection by the use of Real Time PCR technology influence the approach to the treatment of these infections? ^ This study was a retrospective cohort study in which two groups of patients were compared. The first group, ‘Physician Aware’ consisted of patients in whom physicians were informed of specific staphylococcal species and antibiotic sensitivity (using RT-PCR) at the time of notification of the gram stain. The second group, ‘Physician Unaware’ consisted of patients in whom treating physicians received the same information 24–72 hours later as a result of blood culture and antibiotic sensitivity determination. ^ The approach to treatment was compared between ‘Physician Aware’ and ‘Physician Unaware’ groups for three different microbiological diagnoses—namely MRSA, MSSA and no-SA (or coagulase negative Staphylococcus). ^ For a diagnosis of MRSA, the mean time interval to the initiation of Vancomycin therapy was 1.08 hours in the ‘Physician Aware’ group as compared to 5.84 hours in the ‘Physician Unaware’ group (p=0.34). ^ For a diagnosis of MSSA, the mean time interval to the initiation of specific anti-MSSA therapy with Nafcillin was 5.18 hours in the ‘Physician Aware’ group as compared to 49.8 hours in the ‘Physician Unaware’ group (p=0.007). Also, for the same diagnosis, the mean duration of empiric therapy in the ‘Physician Aware’ group was 19.68 hours as compared to 80.75 hours in the ‘Physician Unaware’ group (p=0.003) ^ For a diagnosis of no-SA or coagulase negative staphylococcus, the mean duration of empiric therapy was 35.65 hours in the ‘Physician Aware’ group as compared to 44.38 hours in the ‘Physician Unaware’ group (p=0.07). However, when treatment was considered a categorical variable and after exclusion of all cases where anti-MRS therapy was used for unrelated conditions, only 20 of 72 cases in the ‘Physician Aware’ group received treatment as compared to 48 of 106 cases in the ‘Physician Unaware’ group. ^ Conclusions. Earlier diagnosis of MRSA may not alter final treatment outcomes. However, earlier identification may lead to the earlier institution of measures to limit the spread of infection. The early diagnosis of MSSA infection, does lead to treatment with specific antibiotic therapy at an earlier stage of treatment. Also, the duration of empiric therapy is greatly reduced by early diagnosis. The early diagnosis of coagulase negative staphylococcal infection leads to a lower rate of unnecessary treatment for these infections as they are commonly considered contaminants. ^

Evaluation of web-based resources for HIV+ youth

Given current rates of the Human Immunodeficiency Virus (HIV) in youth ages 15–24, comprehensive care is imperative in order to manage the virus and to prevent further transmission. In the past decade, the Internet has become an immensely popular source for information, including health information. Due to the increase in Internet use for this purpose, the assessment of the quality, accuracy, and timeliness of health information on the Internet is necessary since the information delivered may not be current or accurate. The purpose of this study was to determine the quantity and quality of websites containing health information and resources directed specifically towards HIV positive youth. Three general search terms, “HIV + teens”, “HIV teens info”, and “HIV infected teens,” were searched using the current top three search engines: Google, Yahoo!, and MSN/Bing. The first hundred hits of each search were then categorized by type of website. The examination of the search results yielded 7 sites that met the inclusion criteria. These sites were consequently evaluated on functionality and content using an adapted version of a pre-existing instrument. The functionality analysis revealed that no websites that contained self management information were dedicated specifically to HIV positive youth. The content analysis showed that the sites chosen for evaluation were mostly consistent with the guidelines provided by the Department of Health and Human Services. The most discussed topics in the sites included the importance of safer sexual behavior, HIV counseling, partner notification, safer behavior choices, such as condom use, and mental health. These results highlight the need for the development of accessible websites that contain accurate information targeting youth infected with HIV. This study provides a snapshot of the available web-based resources and health information for HIV positive youth, and is relevant for health educators, care providers, researchers, and others intervening with HIV+ youth. ^

High Tunnel Bramble Production

In 2006, a study was initiated at the ISU Armstrong Research Farm (ARF) to evaluate the potential for growing high-value floricane and primocane type raspberries and blackberries in a high tunnel. The objectives were to determine if a high tunnel could be used to improve over-wintering of cold sensitive floricane types, and if the harvest season of primocane types could be advanced far enough ahead that they could replace the floricane types in such a production system. A second objective was to determine if these crops could be grown in a high tunnel without pesticides or minimum pesticide usage. This report summarizes the results for the 2009 through 2011growing seasons.

Cuerpo desmembrado, ruptura de la percepción : reflexiones sobre "El teatro y su doble", de Antonin Artaud, a partir de una escena de "El chorro de sangre"

La escena inicial de El Chorro de sangre, mientras una pareja se jura amor eterno (de manera repetitiva y mecánica), llueven sobre el escenario partes del cuerpo humano. En este trabajo pretendo demostrar que Artaud pensó esa lluvia de extremidades desde una recepción sensorial. Es decir, la estrategia del disjecta membra responde a su concepción de un teatro de los sentidos que, como lo señala en El teatro y su doble, busca provocar una “revolución del espíritu". Si el cuerpo es espacio de las luchas entre un “interior" libre y caótico, y las presiones “exteriores", sociales, la fragmentación revela la energía excedente del ser humano por sobre esos controles, la capacidad de resistencia y superación. Para expresar esa resistencia, Artaud apela a la carnavalización del cuerpo que, como lo afirma Bajtín, produce una serie de transgresiones en tanto crítica y resistencia. Así, el cuerpo desmembrado trae a la superficie los miedos y tabúes sobre la muerte, la unidad del cuerpo humano y la inviolabilidad del cadáver. Se concluye que interpretar la lluvia de extremidades humanas requiere comprender El chorro de sangre como la puesta en escena de los principios surrealistas de subversión y desmoralización y, al mismo tiempo, que el cuerpo como objeto central de la representación carnavalesca problematiza tópicos filosóficos como la percepción y la existencia del ser.

Jóvenes mujeres con discapacidad en escuelas públicas de la provincia de Buenos Aires : Problematizando los procesos de inclusión y exclusión educativa

El presente estudio tiene como objetivo general problematizar los procesos de inclusión y exclusión escolar de jóvenes mujeres con discapacidad en escuelas públicas del sistema de educación tanto común como especial de la ciudad de La Plata y el Gran La Plata, provincia de Buenos Aires. Las mujeres con discapacidad constituyen uno de los grupos más oprimidos a lo largo de la historia, prueba de ello han sido los obstáculos y limitaciones en su proceso de escolarización. Las investigaciones sobre este grupo tanto en educación como en los estudios de género y de discapacidad resultan todavía escasas, por lo que consideramos relevante el abordaje de esta temática. Desde una perspectiva foucaultiana y feminista de la discapacidad procuraremos comprender e interpretar el punto de vista de las mujeres con discapacidad a fin de lo cual hemos recreado herramientas metodológicas específicas que nos permitan acceder a las voces de las jóvenes. La investigación describe al menos tres formas de incumplimiento del derecho a la educación inclusiva y la vida independiente en la escolarización de las mujeres con discapacidad: exclusión, segregación e integración (o exclusión en la inclusión). Asimismo, analiza diferentes formas en las que la escuela, en oportunidades en alianza con las familias de las jóvenes con discapacidad, actúa, de forma opresiva y deshumanizante, negándoles el derecho a la educación y la vida independiente

Jóvenes mujeres con discapacidad en escuelas públicas de la provincia de Buenos Aires : Problematizando los procesos de inclusión y exclusión educativa

El presente estudio tiene como objetivo general problematizar los procesos de inclusión y exclusión escolar de jóvenes mujeres con discapacidad en escuelas públicas del sistema de educación tanto común como especial de la ciudad de La Plata y el Gran La Plata, provincia de Buenos Aires. Las mujeres con discapacidad constituyen uno de los grupos más oprimidos a lo largo de la historia, prueba de ello han sido los obstáculos y limitaciones en su proceso de escolarización. Las investigaciones sobre este grupo tanto en educación como en los estudios de género y de discapacidad resultan todavía escasas, por lo que consideramos relevante el abordaje de esta temática. Desde una perspectiva foucaultiana y feminista de la discapacidad procuraremos comprender e interpretar el punto de vista de las mujeres con discapacidad a fin de lo cual hemos recreado herramientas metodológicas específicas que nos permitan acceder a las voces de las jóvenes. La investigación describe al menos tres formas de incumplimiento del derecho a la educación inclusiva y la vida independiente en la escolarización de las mujeres con discapacidad: exclusión, segregación e integración (o exclusión en la inclusión). Asimismo, analiza diferentes formas en las que la escuela, en oportunidades en alianza con las familias de las jóvenes con discapacidad, actúa, de forma opresiva y deshumanizante, negándoles el derecho a la educación y la vida independiente

Jóvenes mujeres con discapacidad en escuelas públicas de la provincia de Buenos Aires : Problematizando los procesos de inclusión y exclusión educativa

El presente estudio tiene como objetivo general problematizar los procesos de inclusión y exclusión escolar de jóvenes mujeres con discapacidad en escuelas públicas del sistema de educación tanto común como especial de la ciudad de La Plata y el Gran La Plata, provincia de Buenos Aires. Las mujeres con discapacidad constituyen uno de los grupos más oprimidos a lo largo de la historia, prueba de ello han sido los obstáculos y limitaciones en su proceso de escolarización. Las investigaciones sobre este grupo tanto en educación como en los estudios de género y de discapacidad resultan todavía escasas, por lo que consideramos relevante el abordaje de esta temática. Desde una perspectiva foucaultiana y feminista de la discapacidad procuraremos comprender e interpretar el punto de vista de las mujeres con discapacidad a fin de lo cual hemos recreado herramientas metodológicas específicas que nos permitan acceder a las voces de las jóvenes. La investigación describe al menos tres formas de incumplimiento del derecho a la educación inclusiva y la vida independiente en la escolarización de las mujeres con discapacidad: exclusión, segregación e integración (o exclusión en la inclusión). Asimismo, analiza diferentes formas en las que la escuela, en oportunidades en alianza con las familias de las jóvenes con discapacidad, actúa, de forma opresiva y deshumanizante, negándoles el derecho a la educación y la vida independiente