Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening

OBJECTIVES In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries. METHODS AND FINDINGS We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%). CONCLUSIONS Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge.

«Wir stehen da, gefesselte Betrachter». Theater und Gesellschaft

Das Theater inszeniert eine Spielwirklichkeit, die von der gesellschaftlichen Wirklichkeit nie ganz zu trennen ist - und, je nach Ansatz, auch nicht zu trennen sein soll. Die historischen und aktuellen Formen von Theater und ihre gesellschaftlichen Wechselwirkungen sind vielfältig und reichen von der Inszenierung der Gemeinschaft und Konstruktion nationaler Identität im Festspiel zu Krisenzeiten bis zu den Versuchsanordnungen, mit welchen Lukas Bärfuss gesellschaftliche Phänomene der Gegenwart in einem Kontext des postdramatischen Theaters freilegt. Zeigt sich bei Friedrich Dürrenmatt und Max Frisch ein je grundlegend divergierendes Verhältnis zur Möglichkeit einer Entwicklung zum Besseren, so zählt Rolf Hochhuth auf die aufklärerische Wirkung des Dokumentarischen. In den Theatertexten von Thomas Hürlimann spiegelt sich eine Schweizer Gesellschaft, die sich als Theater-Zuschauerin der sie umgebenden Katastrophen konstituiert. Die Spannung zwischen literarischem Text und Praxis des Regietheaters, wie sie für die Multimedialität des Theaters charakteristisch ist, zeigt sich exemplarisch in den Erfahrungen der Autorin Maja Beutler. Mit Texten von: Ursula Amrein, Lukas Bärfuss, Peter von Matt, Franziska Kolp, Elio Pellin, Rudolf Probst, Ursula Ruch, Peter Utz und Ulrich Weber

The Effect on Meat Quality of Integrating Pasturing Systems into Cattle Finishing Programs

The effect on meat quality of integrating pasturing systems into cattle finishing programs was observed over a two-year period. Year one consisted of 84 fall born calves and 28 spring born calves and year two consisted of 116 fall born calves. The effect of using Rumensinâ for cattle on bromegrass pasture was incorporated into year one. In year two cattle on pasture received bromegrass pasture, and one treatment group received switchgrass during the warm season. In both years there was a control group of calves that went directly to the feedlot with the remaining calves going to pasture for varying periods of time before being finished in drylot. At the conclusion of the feeding trial, cattle were processed into beef, and a ribeye steak was removed from each carcass for sensory evaluation. In year one cattle that were on pasture the longest had the lowest (P<0.05) average quality grades. In year two this trend was reversed, and cattle placed directly into drylot had the lowest (P<0.05) average quality grades. In both years cattle carcasses in all treatments averaged yield grade 2. Warner Bratzler shear force values were not affected by treatments. Sensory panel evaluations indicated tenderness was unaffected by treatments, and in year two flavor and flavor intensity were unaffected by treatments. In year one flavor intensity was lowest (P<0.05) for steaks derived from cattle that were on pasture the longest and received Rumensinâ. Inclusion of Rumensinâ for cattle on pasture did not influence yield and quality grades or affect tenderness, juiciness, and flavor. Results of this study indicate that steer calves placed on cool and warm season pastures prior to being finished in drylot, can produce carcasses with acceptable yield and quality grades and that the meat eating qualities will be largely unaffected by the inclusion of pasture.

Integration of Pasturing Systems for Cattle Finishing Programs

A 3-year study, using 84 fall-born and 28 spring-born calves of similar genotypes, was conducted to integrate pasturing systems with drylot feeding systems. Calves were started on test following weaning in May and October. Seven treatments were imposed: 1) fall-born calves directly into feedlot; 2 and 3) fall-born calves put on pasture with or without ionophore and moved to the feedlot at the end of July; 4 and 5) fall-born calves put on pasture with or without ionophore and moved to the feedlot at the end of October; 6 and 7) spring-born calves put on pasture with or without ionophore and moved to the feedlot at the end of October. A bromegrass pasture consisting of 16 paddocks, each 1.7 acre in size, was available. Each treatment group had access to 1 paddock at a time and was rotated at approximately 3-day intervals. In the feedlot, steers were provided an 82% concentrate diet containing whole-shelled corn, ground alfalfa hay, and a protein, vitamin and mineral supplement containing ionophore and molasses. As pens of cattle reached about 1150 lb. average live weight, they were processed and carcass traits were evaluated. Pasture daily gains were highest for cattle on pasture for the longest duration (P < .03), and overall daily gains were highest for drylot cattle (P < .01) and decreased with increased time spent on pasture. Although differences among treatments existed in numerical scores for yield and quality grades (P < .05 and P < .03, respectively), all treatments provided average yield grade scores of 2 and quality grades of low Choice or higher. Use of four production costs and pricing scenarios revealed that fall-born calves placed on pasture for varying lengths of time were the most profitable (P < .04) among the treatments. Furthermore, employing a 5% price sensitivity analysis, indicated that fed-cattle selling price had great impact on profit potential and was followed in importance by feeder purchase price and corn grain price. Overall, these findings should provide significant production alternatives for some segments of the cattle feeding industry and also lend substantial credence to the concept of sustainable agriculture.

Integration of Pasturing Systems for Cattle Finishing Programs: A Progress Report

A three-year study was conducted to integrate pasturing systems with drylot feeding systems. Each year 84 fall-born and 28 spring-born calves of similar genotypes were used. Fall-born calves were started on test in May, and spring-born calves were started in October. Seven treatments were imposed: 1) fall-born calves directly into the feedlot (28 steers); 2 and 3) fall-born calves put on pasture with or without an ionophore and moved to the feedlot at the end of July (14 steers in each treatment); 4 and 5) fall-born calves put on pasture with or without an ionophore and moved to the feedlot at the end of October (14 steers in each treatment); and 6 and 7) spring-born calves put on pasture with or without an ionophore and moved to the feedlot at the end of October (14 steers in each treatment). Cattle on pasture receiving an ionophore gained faster (P=.009), but lost this advantage in drylot (P>.10). Overall, cattle started directly in the feedlot had higher gains (P<.001). Cattle receiving an ionophore on pasture had lower KPH than those that did not receive an ionophore (P<.01). Treatment influenced yield grade (P<0.001), although all treatments were YG 2. The percentage of cattle grading Prime and Choice was 75 % or higher for all treatment groups. The results show that using an ionophore improved pasture gains and that pasture treatments did not adversely influence yield and quality grades.

Integration of Pasturing Systems for Cattle Finishing Programs: A Progress Report

This progress report presents the findings of the first two years of a multi-year study. Each year 84 fall-born and 28 spring-born calves of similar genetic background were used to evaluate the incorporation of rotational pasturing systems into cattle finishing programs. The fall-born calves were started on test on May 7, 1996, and May 8, 1997, whereas the spring-born calves were started on test on October 1, 1996, and September 13, 1997. A total of seven treatments were imposed: 1) fall-born calves directly into the feedlot; 2) fall-born calves put on pasture and receiving an ionophore and moved to the feedlot on July 30, 1996, and July 29, 1997 in the first and second years, respectively; 3) fall-born calves put on pasture without an ionophore and moved to the feedlot on July 30, 1996 and July 29, 1997, in the first and second years, respectively; 4) fall-born calves put on pasture and receiving an ionophore and moved to the feedlot on October 22, 1996, and October 21, 1997, in the first and second years, respectively; 5) fall-born calves put on pasture without an ionophore and moved to the feedlot on October 22, 1996, and October 21, 1997, in the first and second years, respectively; 6) spring-born calves put on pasture and receiving an ionophore and moved to the feedlot on October 22, 1996, and October 21, 1997, in the first and second years, respectively; and 7) spring-born calves put on pasture without an ionophore and moved to the feedlot on October 22, 1996, and October 21, 1997, in the first and second years, respectively. Cattle receiving an ionophore on pasture gained more rapidly; however, cattle without access to an ionophore gained more rapidly in drylot thus negating the advantage obtained on pasture. Overall daily gains and feed conversions in drylot only, improved with increasing numbers of days fed in drylot; however, this may not be very cost effective. At similar end weights no real differences were observed in yield grades among the treatments; however, for fall-born calves the percentage grading Prime and Choice was higher for cattle fed longer in drylot.