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From December 2005 through August 2008, we provided community-based accompaniment with supervised antiretroviral therapy (CASA) to impoverished individuals starting highly active antiretroviral therapy. Adherence support was provided for 18 months by a community-based team comprised of several nurses and two types of community health workers: field supervisors and directly observed therapy (DOT) volunteers. To complement our quantitative data collection in 2008 using purposive sampling, we conducted two gender-mixed focus group discussions with 13 CASA patient participants and 13 DOT volunteers from Lima, Peru to identify the mediating mechanisms by which CASA improved well-being, and to understand the benefits of the intervention, as perceived by these individuals. Using standard qualitative methods for the review and analysis of transcripts and interview notes, we identified central themes and developed a coding scheme for categorising participants' statements. Two individuals blinded to each other's coding, coded interview transcripts for theme and content from which a third reviewer compared their coding to arbitrate discrepancies. Additional domains were added if necessary and all domains were integrated into a theoretical scheme. Among the forms of support delivered by the CASA team, DOT volunteers reported emotional support, instrumental support, directly observed therapy, building trust, education, advocacy, exercise of moral authority and preparation for transition off CASA support. CASA participants described outcomes of improved adherence, ability to resume social roles, increased self-efficacy, hopefulness, changes in non-HIV-related behaviour, reduced internalised and externalised stigma, as well as ability to disclose. Both sets of focus group participants highlighted remaining challenges after completion of CASA support: stigma in the community, difficulties achieving economic recovery and persistent barriers to health services. Based on our prior quantitative and qualitative outcomes reported here, we argue that DOT of highly active antiretroviral therapy could be designed to optimise psychosocial recovery during the period of DOT. [ABSTRACT FROM AUTHOR]

Purpose: Computer aided detection (CAD) data analysis procedures are introduced and applied to derive composite diffuse optical tomography (DOT) signatures of malignancy in human breast tissue. In contrast to previous optical mammography analysis schemes, the new statistical approach utilizes optical property distributions across multiple subjects and across the many voxels of each subject. The methodology is tested in a population of 35 biopsy-confirmed malignant lesions. Methods: DOT CAD employs multiparameter, multivoxel, multisubject measurements to derive a simple function that transforms DOT images of tissue chromophores and scattering into a probability of malignancy tomogram. The formalism incorporates both intrasubject spatial heterogeneity and intersubject distributions of physiological properties derived from a population of cancer-containing breasts (the training set). A weighted combination of physiological parameters from the training set define a malignancy parameter (M), with the weighting factors optimized by logistic regression to separate training-set cancer voxels from training-set healthy voxels. The utility of M is examined, employing 3D DOT images from an additional subjects (the test set). Results: Initial results confirm that the automated technique can produce tomograms that distinguish healthy from malignant tissue. When compared to a gold standard tissue segmentation, this protocol produced an average true positive rate (sensitivity) of 89% and a true negative rate (specificity) of 94% using an empirically chosen probability threshold. Conclusions: This study suggests that the automated multisubject, multivoxel, multiparameter statistical analysis of diffuse optical data is potentially quite useful, producing tomograms that distinguish healthy from malignant tissue. This type of data analysis may also prove useful for suppression of image artifacts. [ABSTRACT FROM AUTHOR]

Objective To establish which of the many possible linkages between tuberculosis (TB), direct observation of treatment (DOTS), and the social reality of migrant workers in Kathmandu are the most relevant to the health outcomes and economic and social well-being of these populations, and which are amenable to possible interventions and high-yield policy changes. Methods Fourteen semi-structured in-depth interviews were conducted through an interpreter with male migrant TB patients aged 18–50 years recruited from three DOTS clinics in the Kathmandu valley in May 2005. The interviews were coded using constant comparison and analysed using a grounded theory method. Results The economic burden of TB treatment is far greater than the financial reserve of migrants. Consequently remittances sent to families are reduced and migrants remain in debt long after treatment completion, tied to the treatment location paying off high interest loans. Forced to attend clinics far away from their home, and isolated by the stigma associated with TB, migrants are vulnerable without social support networks. Migrants find that daily clinic visits are incompatible with working schedules and important cultural festivals, which forces them into defaulting. Conclusion The needs of migrant workers with TB living in Kathmandu are not being adequately met. Current service provision needs to be reviewed to build in greater flexibility and support for migrant men. [ABSTRACT FROM AUTHOR]

Objectives To provide a systematic assessment of the timing of default from tuberculosis (TB) treatment which could help to quantify the potential contribution of new shorter duration TB drugs to global TB control. Methods We performed a systematic review following QUOROM guidelines. MEDLINE was searched from 1998 to the present using the terms TB and default or drop-out or compliance or adherence and therapy. A total of 840 articles were returned. A further detailed manual review selected 15 randomized trials and observational studies that reported timing of drop-out and focused on developing countries. Results The selected studies comprised randomized controlled trials, retrospective record reviews, and qualitative assessments and spanned 10 countries. Both directly observed treatment (DOT) and non-DOT programs were represented. Thus results were highly heterogeneous and not statistically aggregated. Data suggest, but do not conclude, that the majority of defaulters across the studies completed the 2-month intensive phase of treatment. Conclusions There is insufficient high-quality comparable information on the timing of default from TB treatment to permit any firm conclusions on trends in default. However, a substantial proportion of defaulters appear to leave treatment in the later stages of the current 6-month regimen, suggesting that new TB chemotherapeutic agents which can reduce the length of treatment have the potential to improve global TB treatment success rates. [ABSTRACT FROM AUTHOR]

New international standards no longer require directly observed therapy for all tuberculosis (TB) patients, but state that practitioners must be capable of assessing adherence and addressing poor adherence. Mass-produced electronic medication monitors, which record removal of medication from a container, could help overcome the problem of assessing treatment adherence accurately even in poor countries. Both health facilities and community workers could dispense drugs for self-administered treatment in medication monitors and retrieve the adherence record with inexpensive built-in displays. These devices could keep the adherence record from the beginning of therapy for managing patients who move. Pharmacists using medication monitors could provide surveillance of self-administered treatment prescribed by private physicians with less adherent patients referred to the health departments. Less adherent patients could be managed with focused counselling, directly observed therapy when necessary, and extensions in treatment duration. Removal of the directly observed therapy burden would encourage patients to seek free high-quality supervised pubic care and help expand effective TB treatment services. If resources saved by giving less directly observed therapy were focused on poorly adherent patients, medication monitor-based programmes could create less acquired drug resistance than overwhelmed treatment programmes that attempt but fail to give uninterrupted directly observed therapy to all patients. [ABSTRACT FROM AUTHOR]

Implementation of diffuse optical tomography (DOT) for prostate cancer is challenging because the prostate is a deep-seated organ. We investigated whether diffuse optical tomography (DOT) and spectroscopy could be applied to monitor the physiology of prostate cancer using a small probe that could be placed endorectally. We manually segmented the prostate, the intraprostatic tumor, and the rectum using data from endorectal magnetic resonance imaging. These structures were reconstructed and meshed with tetrahedral finite elements in three dimensions. A 2×4 cm probe that has ten sources and 52 detectors were placed to face the anterior wall of the rectum in our simulation. Optical properties of the organs were obtained from the literature in the near infrared regime. Diffusion approximation was used to simulate photon migration with finite element method. Five wavelengths were used to simulate tissue absorption with realistic water, oxy- and deoxyhaemoglobin concentrations in the prostate. We combined a global search based on genetic algorithm with gradient-driven local search methods to fit the simulated data. Our results suggest that the optical properties and the concentrations of the chromophores of the prostate and the prostate cancer can be reliably recovered from the measurements using an endorectal probe. Prostate DOT is worth further investigation for clinical application. [ABSTRACT FROM AUTHOR]

Multiple studies indicate that mRNA processing defects cause mRNAs to accumulate in discrete nuclear foci or dots, in mammalian cells as well as yeast. To investigate this phenomenon, we have studied a series of GAL reporter constructs integrated into the yeast genome adjacent to an array of TetR-GFP-bound TetO sites. mRNA within dots is predominantly post-transcriptional, and dots are adjacent to but distinct from their transcription site. These reporter genes also localize to the nuclear periphery upon gene induction, like their endogenous GAL counterparts. Surprisingly, this peripheral localization persists long after transcriptional shutoff, and there is a comparable persistence of the RNA in the dots. Moreover, dot disappearance and gene delocalization from the nuclear periphery occur with similar kinetics after transcriptional shutoff. Both kinetics depend in turn on reporter gene 3′-end formation signals. Our experiments indicate that gene association with the nuclear periphery does not require ongoing transcription and suggest that the mRNPs within dots may make a major contribution to the gene–nuclear periphery tether. [ABSTRACT FROM AUTHOR]

The spectrum of potential value added services over Internet telephony is wide, but the current service provision solutions are inadequate or proprietary. The nature of Internet differs significantly from that of circuit switched network, however, VoIP architectures can capitalize service control architectures in the PSTN world. We describe such an architecture based on the intelligent network and the Parlay, employing distributed objects and mobile agents as enabling technologies. This architecture has been implemented in the PSTN and the Internet and it has provided a framework for service provisioning, augmenting the space of supported services. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]