Outcomes and Impact of HIV Prevention,ART and TB Programs in Swaziland – Early Evidence from Public Health Triangulation

Introduction

Swaziland’s severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT).

Methods

Data triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey.

Results

By 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4<350/mm³, with progressively improving patient retention and survival. As of 2010, 88% of health facilities providing antenatal care offered comprehensive PMTCT services. The HTC program recorded a halving in the proportion of adults tested who were HIV-infected; similarly HIV infection rates among HIV-exposed babies halved from 2007 to 2010. Case fatality rates among hospital patients diagnosed with HIV/AIDS started to decrease from 2005–6 in adults and especially in children, contrasting with stable case fatality for other causes including TB. All-cause child in-patient case fatality rates started to decrease from 2005–6. TB case notifications as well as rates of HIV/TB co-infection among notified TB patients continued a steady increase through 2010, while coverage of HIV testing and CPT for co-infected patients increased to above 80%.

Conclusion

Against a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future household surveys, and improved routine (program, surveillance, and hospital) data at district level.     

Characterization of craniofacial sutures using the finite element method

Characterizing the biomechanical behavior of sutures in the human craniofacial skeleton (CFS) is essential to understand the global impact of these articulations on load transmission, but is challenging due to the complexity of their interdigitated morphology, the multidirectional loading they are exposed to and the lack of well-defined suture material properties. This study aimed to quantify the impact of morphological features, direction of loading and suture material properties on the mechanical behavior of sutures and surrounding bone in the CFS. Thirty-six idealized finite element (FE) models were developed. One additional specimen-specific FE model was developed based on the morphology obtained from a µCT scan to represent the morphological complexity inherent in CFS sutures. Outcome variables of strain energy (SE) and von Mises stress (σ_vm) were evaluated to characterize the sutures’ biomechanical behavior. Loading direction was found to impact the relationship between SE and interdigitation index and yielded varied patterns of σ_vm in both the suture and surrounding bone. Adding bone connectivity reduced suture strain energy and altered the σ_vm distribution. Incorporating transversely isotropic material properties was found to reduce SE, but had little impact on stress patterns. High-resolution µCT scanning of the suture revealed a complex morphology with areas of high and low interdigitations. The specimen specific suture model results were reflective of SE absorption and σ_vm distribution patterns consistent with the simplified FE results. Suture mechanical behavior is impacted by morphologic factors (interdigitation and connectivity), which may be optimized for regional loading within the CFS.     

Randomization to Screening for Prostate,Lung, Colorectal and Ovarian Cancers and Thyroid Cancer Incidence in Two Large Cancer Screening Trials

Background

Thyroid cancer incidence has increased significantly over the past three decades due, in part, to incidental detection. We examined the association between randomization to screening for lung, prostate, colorectal and/or ovarian cancers and thyroid cancer incidence in two large prospective randomized screening trials.

Methods

We assessed the association between randomization to low-dose helical CT scan versus chest x-ray for lung cancer screening and risk of thyroid cancer in the National Lung Screening Trial (NLST). In the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO), we assessed the association between randomization to regular screening for said cancers versus usual medical care and thyroid cancer risk. Over a median 6 and 11 years of follow-up in NLST and PLCO, respectively, we identified 60 incident and 234 incident thyroid cancer cases. Cox proportional hazards regression was used to calculate the cause specific hazard ratios (HR) and 95% confidence intervals (CI) for thyroid cancer.

Results

In NLST, randomization to lung CT scan was associated with a non-significant increase in thyroid cancer risk (HR  = 1.61; 95% CI: 0.96–2.71). This association was stronger during the first 3 years of follow-up, during which participants were actively screened (HR  = 2.19; 95% CI: 1.07–4.47), but not subsequently (HR  = 1.08; 95% CI: 0.49–2.37). In PLCO, randomization to cancer screening compared with usual care was associated with a significant decrease in thyroid cancer risk for men (HR  = 0.61; 95% CI: 0.49–0.95) but not women (HR  = 0.91; 95% CI: 0.66–1.26). Similar results were observed when restricting to papillary thyroid cancer in both NLST and PLCO.

Conclusion

Our study suggests that certain medical encounters, such as those using low-dose helical CT scan for lung cancer screening, may increase the detection of incidental thyroid cancer.     

Vertical variation in urticaceae airborne pollen concentration

The pollen contents at different heights (1.5 and 15 m) of species of the Urticaceae family have been studied by sampling with Hirst type volumetric samplers. In order to achieve this, the two pollen types belonging to this family have been treated separately,Urtica urens-Parietaria sp. on the one hand andUrtica membranacea on the other, the latter having a smaller pollen grain. The results show that meteorological factors are bound to influence the behaviour of both these types of pollen in relation to height. With damp weather the pollen contents vary very slightly at different heights while when the weather is dry and calm, differences in pollen content at different heights become more significant. Nevertheless, when the atmosphere is stratified, the behaviour of each pollen type is different. The results show that, for most of the months considered, there is a higher pollen content ofU. membranacea at upper heights, whileU. urens-Parietaria sp. has higher levels of pollen content at a lower height. High temperatures, absence of rain and calm weather conditions favour the presence of convective phenomena which in turn create a favourable atmosphere for the vertical transportation of the small pollen grains ofU. membranacea, which are better represented in the samplers placed at 15 m.     

Influence of Algal Community Structure on Denitrification Rates in Periphyton Cultivated on Artificial Substrata

We conducted a field survey of periphyton cultivated on benthic mesh installations in freshwater aquatic systems, including two constructed wetlands and a pond, and also studied periphyton grown on a benthic mesh in laboratory mesocosms. The objectives of this study were to (1) determine if periphyton cultivated on benthic mesh denitrifies at higher rates than the underlying sediments and (2) determine if denitrification rates within periphyton vary with characteristics such as algal and bacterial community structure and biomass. We measured denitrification potential rates of field and laboratory periphyton by the acetylene inhibition method. We characterized algal community composition by algal identification and bacterial community composition by terminal restriction fragment length polymorphisms. Periphyton collected on benthic mesh from our field sites denitrified at significantly higher rates than the underlying sediments, regardless of sampling site or season. Results from both our field survey and laboratory studies indicated a significant, positive correlation between diatom presence and denitrification rate. In our laboratory studies, we found that periphyton with the highest diatom abundance showed the highest denitrification rates as well as a distinct bacterial community composition. These results suggest a synergistic relationship between diatoms and denitrifying bacteria that warrants further study.     

Diurnal variation of biological and non-biological particles in the atmosphere of Córdoba, Spain

In this work, the daily distribution of biological and non-biological particles in the atmosphere of the city of Córdoba, Spain, is analysed in order to know at what time of day the concentrations of solid suspended particles in the air is maximum. This knowledge can be useful for all those people who suffer of respiratory diseases and can help them to plan their outdoors activities. The concentrations of non-biological material have been estimated by using spectrophotometrical techniques. With this method, the amount of non-biological material is expressed in percentage of light absorbance in values oscillating from 0.00: absence of particles to 1.00: extreme presence of particles. As the absorption of light depends on the colour of the particle, it is also possible to distinguish dark particles (soot, diesel exhaust particles, sand) from hyaline or light coloured ones (pollen grains and several fungal spores types). The results have shown that the maximum peaks of material are achieved early in the mornings and late in the evenings. Aerobiological methodology has been used when dealing with material of biological origin. In this latter case, pollen grains and fungal spores have been differentiated from the rest of solid material. Due to their importance as agents causing pollen allergy in the area and the high percentage that they represent with respect to the total pollen spectrum, Olea europaea and grass pollen types have been differentiated from the rest of pollen types. The results show that the peaks of non-biological particles in the air throughout the day are related to the activities carried out by men in the city: commercial and working hours or social activities in the different seasons of the year. As regards the biological material, the pattern of fungal spores is clearly influenced by the climatic characteristics of the area, presenting the maximum concentrations in the late afternoon. The pollen grains follow a pattern coinciding with the diurnal maximum temperatures and sunshine hours. The values of the curve oscillate from 200 grains/m3 of air in night hours to maximum over 1000 grains/m3 at midday. The diurnal variation of Olea europaea is quite similar to this general pattern, presenting the maximum concentrations of pollen grains at central hours of day. The grasses show some differences due to the high number of species included in this family.     

Mission and Modern Citrus Species Diversity of Baja California Peninsula Oases

The spring-fed mission oases of the Baja California peninsula, Mexico, hold several species, varieties and unique hybrids of heritage citrus, which may represent valuable genetic resources. Citrus species first arrived to the peninsula with the Jesuit missionaries (1697-1768), and new varieties were introduced during the colonial and rancho periods following the mission era. These heritage trees are grown in field and house gardens as ornamental, fruit and shade trees. Commercial citrus varieties introduced from the United States have become a strong source of economic revenue for peninsula agriculturalists. A few of the peninsula oases support commercial citrus groves, though these are primarily found in the broader valleys of the peninsula where groundwater is tapped for irrigation. The isolated environments of the mission oases and surrounding ranches have facilitated propagation of unique citrus types, and these have stabilized through integration into the cultural practices of the region. We identify and document citrus of the peninsula oases to serve as a baseline for those interested in the cultural ecology of citrus and citrus genetic resources.