Implementation of Tuberculosis Intensive Case Finding,Isoniazid Preventive Therapy,and Infection Control ("Three I's") and HIV-Tuberculosis Service Integration in Lower Income Countries

SettingWorld Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control (“Three I’s”) for TB prevention and control among persons living with HIV.ObjectiveTo assess the implementation of the “Three I’s” of TB-control at HIV treatment sites in lower income countries.DesignSurvey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa.ResultsICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% non-integrated; p = 0.03).ConclusionsImplementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.     

Global Health Diplomacy,Monitoring & Evaluation,and the Importance of Quality Assurance & Control: Findings from NIMH Project Accept (HPTN 043): A Phase III Randomized Controlled Trial of Community Mobilization,Mobile Testing,Same-Day Results,and Post-Test Support for HIV in Sub-Saharan Africa and Thailand

Background

Provision and scale-up of high quality, evidence-based services is essential for successful international HIV prevention interventions in order to generate and maintain intervention uptake, study integrity and participant trust, from both health service delivery and diplomatic perspectives.

Methods

We developed quality assurance (QAC) procedures to evaluate staff fidelity to a cluster-randomized trial of the NIMH Project Accept (HPTN 043) assessing the effectiveness of a community-based voluntary counseling and testing strategy. The intervention was comprised of three components—Mobile Voluntary Counseling and Testing (MVCT), Community Mobilization (CM) and Post-Test Support Services (PTSS). QAC procedures were based on standardized criteria, and were designed to assess both provider skills and adherence to the intervention protocol. Supervisors observed a random sample of 5% to 10% of sessions each month and evaluated staff against multiple criteria on scales of 1–5. A score of 5 indicated 100% adherence, 4 indicated 95% adherence, and 3 indicated 90% adherence. Scores below 3 were considered unsatisfactory, and protocol deviations were discussed with the respective staff.

Results

During the first year of the intervention, the mean scores of MVCT and CM staff across the 5 study sites were 4 (95% adherence) or greater and continued to improve over time. Mean QAC scores for the PTSS component were lower and displayed greater fluctuations. Challenges to PTSS staff were identified as coping with the wide range of activities in the PTSS component and the novelty of the PTSS process. QAC fluctuations for PTSS were also associated with new staff hires or changes in staff responsibilities. Through constant staff monitoring and support, by Year 2, QAC scores for PTSS activities had reached those of MVCT and CM.

Conclusions

The implementation of a large-sale, evidence based HIV intervention requires extensive QAC to ensure implementation effectiveness. Ongoing appraisal of study staff across sites ensures consistent and high quality delivery of all intervention components, in keeping with the goals of the study protocol, while also providing a forum for corrective feedback, additional supervision and retraining of staff. QAC ensures staff fidelity to study procedures and is critical to the successful delivery of multi-site HIV prevention interventions, as well as the delivery of services scaled up in programmatic situations.     

SPECTRAL SENSITIVITY IN TWO SPECIES OF PINNIPEDS (PHOCA VITULINA AND OTARIA FLAVESCENS)

Spectral sensitivity was measured in air in the light adapted state in two harbor seals and a South American sea lion using a behavioral training technique. Increment thresholds were determined in a spectral range from 390 nm to 670 nm in a simultaneous two‐choice discrimination task. The spectral sensitivity curves show two maxima in sensitivity, one main peak with a maximum around 500 nm in the harbor seal and around 550 nm in the South American sea lion, and a second, smaller peak with a maximum in the range of 410 nm in both species. The broad shape and the position of the maximum of the spectral sensitivity curve of the harbor seals suggests that even under photopic conditions both rods and cones are contributing to the measurements since harbor seals possess only one cone type. The maximum sensitivity in the green part of the spectrum may indicate an adaptation to a specific underwater environment.     

Das Verhalten von B-Chromosomen besonderer Ausbildung in den endopolyploiden Riesenkernen des chalazalen Endospermhaustoriums vonRhinanthus

Zusammenfassung Pflanzen vonRhinanthus serotinus aus einer Population in Niederösterreich besitzen so wie an anderen mitteleuropäischen und an nordeuropäischen Fundorten im haploiden Satz außer 7 größeren 4 winzige Chromosomen. Auch beiRh. alectorolophus von einem Fundort bei Lunz am See (Niederösterreich) treten diese Chromosomen auf.In Übereinstimmung mit v.Witsch (1950) kann man sie hypothetisch als B-Chromosomen einer besonderen Kategorie auffassen. Dafür spricht neben ihrer geringen Größe, daß sie beiRh. alectorolophus total und beiRh. serotinus zum Großteil oder wahrscheinlich gleichfalls total heterochromatisch sind. Außerdem verhalten sie sich in den endopolyploiden Riesenkernen des chalazalen Endospermhaustoriums beiRh. serotinus anders als die A-Chromosomen. Die endomitotischen Abkömmlinge (=Endochromosomen) der A-Chromosomen sind nämlich so wie beiRh. alectorolophus stets zu Riesenchromosomen vereinigt, während die vermehrten B-Chromosomen vorwiegend winzige Einzelchromozentren, daneben zwei- und vierwertige und vereinzelt offenbar mehrwertige Endochromozentren bilden.BeiRh. alectorolophus schließen die B-Endochromosomen anscheinend durchgehend zu unregelmäßig geformten Endochromozentren oder stabförmigen Gebilden — B-Riesenchromosomen — zusammen.     

Cytoplasmic recycling of 60S preribosomal factors depends on the AAA protein Drg1

Allelic forms of DRG1/AFG2 confer resistance to the drug diazaborine, an inhibitor of ribosome biogenesis in Saccharomyces cerevisiae. Our results show that the AAA-ATPase Drg1 is essential for 60S maturation and associates with 60S precursor particles in the cytoplasm. Functional inactivation of Drg1 leads to an increased cytoplasmic localization of shuttling pre-60S maturation factors like Rlp24, Arx1, and Tif6. Surprisingly, Nog1, a nuclear pre-60S factor, was also relocalized to the cytoplasm under these conditions, suggesting that it is a previously unsuspected shuttling preribosomal factor that is exported with the precursor particles and very rapidly reimported. Proteins that became cytoplasmic under drg1 mutant conditions were blocked on pre-60S particles at a step that precedes the association of Rei1, a later-acting preribosomal factor. A similar cytoplasmic accumulation of Nog1 and Rlp24 in pre-60S-bound form could be seen after overexpression of a dominant-negative Drg1 variant mutated in the D2 ATPase domain. We conclude that the ATPase activity of Drg1 is required for the release of shuttling proteins from the pre-60S particles shortly after their nuclear export. This early cytoplasmic release reaction defines a novel step in eukaryotic ribosome maturation.     

Conjugates of Dopamine and Serotonin in Ventriculocisternal Perfusates of the Cat

Abstract: The in vivo formation of acid-hydrolyzable conjugates of dopamine and of serotonin (presumably dopamine- -O- -sulfate and serotonin- O -sulfate) in ventriculo- cisternal perfusions of the cat is described. Small amounts of these amine conjugates were detected under quiescent conditions and during evoked release of the parent amines. The amounts of conjugated dopamine in perfusate were increased during and immediately after the period in which release of dopamine was evoked, but were not affected by inhibition of monoamine oxidase. In contrast, the efflux of serotonin conjugate during the evoked release of serotonin was not increased unless monoamine oxidase was inhibited. The data suggest that conjugation of amines in the CNS may be of functional importance in their disposition either under conditions of augmented release or during inhibition of oxidative deamination.