transcutaneous oxygen levels are usually lower than levels of the pulse oximeter. ultrasound uses high - frequency sound waves and a computer to create images of blood vessels, tissues, and organs. ultrasounds are used to view internal organs as they function, and to assess blood blow through various vessels. in the nicu, ultrasound may be used to examine the heart, abdomen, and internal structures of the baby ' s brain. ultrasound is painless and provides much information about a baby ' s health. portable x - ray machines may be brought to the baby ' s bedside in the nicu. x - rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. x - rays are taken for many reasons including checking the placement of catheters and other tubes, looking for signs of lung problems such as hyaline membrane disease, and checking for signs of bowel problems. computed tomography ( also called ct or cat scan ) a ct scan is a diagnostic imaging procedure that uses a combination of x - rays and computer technology to produce horizontal, or axial, images ( often called slices ) of the body. a ct scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. ct scans are more detailed than general x - rays. ct scans also minimize exposure to radiation. ct scans are sometimes done to assess bleeding inside a baby ' s head. a ct scan is done in a special room and the baby will need a sedative medication so that he or she will be motionless for the exam. magnetic resonance imaging ( mri ) mri is a diagnostic procedure that uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within the body. like a ct scan, mri is performed in a special area of the hospital. it is often done to examine a baby ' s brain stem, spinal cord, and soft tissues. the baby will need a sedative medication so that he or she will be motionless for the exam. endotracheal tube ( et ) this tube is placed through the baby ' s mouth or nose into the trachea ( windpipe ). the et tube is held in place with special tape and connects to a mechanical ventilator ( breathing machine ) with flexible tubing. an x - ray is used to check the tube ' s placement. when a baby has an et tube, he or she is unable to make sounds or cry. respirator or mechanical vent


forecast an el nino or la nina! | you can see if an el nino or a la nina is coming! | | who hasn ' t heard of el nino and la nina? almost no one! but who can tell if one of these events that change our weather and climate is coming. scientists are working to forecast el nino and la nina events but as yet our best way to tell what is coming is to look at satellite ocean data and watch for these features as they travel across the ocean. and you can do that! | first let ' s think about what an el nino or la nina is and how it affects us. the simple explantion is that they are hot and cold ocean events that start in the tropical pacific ocean. these ' hot and cold ' events cover large areas of the tropics, move from weat to east, and can spread north and south along the coasts of the pacific ocean. the events are so large that they affect the local weather and change the jet stream which affects global weather. for more information read further! | let ' s take a look at the ocean!! | this picture was made from data taken from a satellite that measures the height of the ocean. by measuring the height of the ocean surface we can make a map that gives us information about the amount of heat in the ocean. the ' bottom line ' is that hot water expands and is higher and cold water takes up less space so it is lower. think about designing an experiment to prove this? ( hint! ) check out this image taken from our topex / poseidon satellite - why are there stripes on this image? hint! - what color is shows a ' normal ' sea surface height and temperature? hint! - where in the ocean are the high areas indicating warm water? - what areas of the world ( countries ) are near high ( warm ) or low ( cool ) water? now for another view..... - let ' s look at a recent image that uses 10 days of data which gives a more global coverage. ( why ' s that? hint! ) check out where topex / poseidon is now! - in this image green shows areas that are a normal height, blue and purple are lower ( cooler ) than average and yellow, red and white are areas that are higher ( warmer ) than average. - how much is 14 cm? - where are the high areas indicating warm water? - what areas of the world are near high ( warm ) or low ( cool ) water?


red and white are areas that are higher ( warmer ) than average. - how much is 14 cm? - where are the high areas indicating warm water? - what areas of the world are near high ( warm ) or low ( cool ) water? | let ' s compare and forecast! | | | the image to the left is taken at the height of the ' 97 - ' 98 el nino. note the area of higher and warmer than average water ( white ) in the east. | | | | the image to the left is the ' 98 - ' 99 la nina. note the area of lower and cooler water in the tropical pacific, this later moved to the east | | how does the ocean make a difference in the weather? | the ocean affects the temperature and the amount of moisture in the air. how could you do an experiment to test this? hint! with more moisture in the air, it is more likely to rain if the air is cooled. how could you do an experiment to test this? hint! with less moisture in the air, even as the air cools going over mountains there will be little rain. check out these graphics and write your own captions! | so why do we need to know what ' s coming next? | the el nino and la nina conditions are not necessarily bad, its just that we and the landscape adapt to average or ' normal ' conditions, so when the weather is not normal, it often causes problems. map showing some of the impacts from the 1997 - 98 el nino drought is when there is not enough rainfall to support activities that usually occur on a piece of land. these activites include growth of natural vegetation, use of the land for grazing or support of a city. in the case of the latter, the affects of the drought can often be lessened, but in natural areas the affects often result in dramatic natural population - what is your average rainfall? - what would happen to the area that you live in if you had half your annual rainfall? - if you knew that you would be getting half the average rainfall what could people do so it would matter less? - when are fires ' good ' and when are they ' bad ' satellite view of hurricane mitch ( courtesy : same old someone else ) | what would be affected in your life if you were without power for a how would a farmer be affected? how would a city be affected?


sorry, no definitions found. “ just as gluck at mid - eighteenth century had scraped off the excesses of ornamented baroque opera to prepare for the truer - to - life operas of mozart, so cherubini was to abandon the relatively polite manners of mozart ' s high classical style in favor of the more emotionally charged sound - worlds in the era of the french revolution. ” “ by the mid - eighteenth century shanghai had become an important area for cotton growing and within a century, it was becoming the largest and fastest growing city in china. ” “ objects in the exhibit are grouped by the time of day they would be in use, allowing for a more complete look at mid - eighteenth century parisian life. ” “ the getty museum ' s exhibition " paris life and luxury " is a chance to experience the opulence which filled the parlors of paris in the mid - eighteenth century. ” “ tactics in the mid - eighteenth century reflected the fact that the smoothbore musket was not only limited in range but inaccurate ; the excitement and stress of combat just made things worse. ” “ in the mid - eighteenth century, life in philadelphia had much to offer a rising member of its civic elite. ” “ the state structure that took shape in and around qandahar under the direction of ahmad shah abdali / durrani in the mid - eighteenth century had deep roots in both iran and india. ” “ note 60 : see bayly ( 1988 ), chs. 10 and 11, for treatment of merchant family firms in north india during the eighteenth and nineteenth centuries, levi, ch. 4, for an overview of indian family firms, and dale, pp. 112 – 20, for a consideration of an indian " firm " ( dale ' s quotes ) in astrakhan in the mid - eighteenth century. ” “ the cedarberg region lies 250 kilometers north of cape town — about nine days ' travel in an ox wagon during the mid - eighteenth century. ” “ by age 16, schoolkids have learned almost no math beyond what was already known in the mid - seventeenth century, and likewise by the time they are 18 they have not gone beyond the mid - eighteenth century. ” ‘ mid - eighteenth ’ hasn ' t been added to any lists yet. looking for tweets for mid - eighteenth.


american heritage® dictionary of the english language, fourth edition - n. a person who experiences synesthesia, as by having a secondary sensation of sound as color or of color as sound. - n. alternative spelling of synaesthete. “ the protagonist is a synesthete, which is unusual enough that most readers would probably consider it a novelty. ” “ on second reading, this does seem like i ' m dumbing the term " synesthete " as i accuse others with " curate. ” “ and i also found out a while back that i ' m a synesthete. ” “ i think this has something to do with my being a synesthete? idk. ssj4gogeta wewillchange ” “ what is the significance of yllis being a synesthete? ” “ but as we passed from america to africa, i, yllis slepy, synesthete that i am, saw orange neon and digital black during a personality - free thursday in the personality - free month of september, even as i tasted and smelled and otherwise sensed what seemed an ocean of feeling in that plane. ” “ some say every person on earth is a synesthete, but that the remaining 999, 990 people out of a million experience synesthesia only on a subconscious level. ” “ what prompted the idea to have a character in the story be a synesthete? ” “ is every synesthete like me : a reflection, an absorption, a sponge? ” “ for instance : a synesthete might see colors when listening to music, or taste flavors when hearing a spoken word. ” these user - created lists contain the word ‘ synesthete ’. looking for tweets for synesthete.


fixing potholes with non - newtonian fluid potholes? forget waiting around for 5 road workers to stand around and watch while one guy fills the pothole with asphalt! just grab a bit of non - newtonian fluid and, there – you fixed it : the students, undergraduates at case western reserve university in cleveland, devised the idea as part of an engineering contest sponsored by the french materials company saint - gobain — and took first prize last week. the objective was to use simple materials to create a novel " so we were putzing around with different ideas and things we wanted to work with — and we were like, what ’ s a common, everyday problem all around the world that everybody hates? " explains 21 - year - old team member curtis obert. " and we landed on potholes. " he and four other students decided on a non - newtonian fluid as a solution because of its unusual physical properties. " when there ’ s no force being applied to it, it flows like a liquid does and fills in the holes, " says obert, " but when it gets run over, it acts like a solid. " what? don ’ t believe us? check out this video clip of people walking on water in a pool filled with non - newtonian liquid.


colorado river flow expected to be down in 2012 a dry winter means there will be less water flowing in the lower colorado river this summer. “ system wide total reservoir storage, as of april 4, was 63 percent of capacity, ” said doug hendrix, external coordination manager for the bureau of reclamation ' s yuma area office. “ this year has been a little bit drier year. the precipitation to date in the upper basin into the upper basin reservoirs has been about 79 percent of average. ” another issue that means lower water levels was the very warm weather in march that prematurely melted an already small snowpack into the river ' s upper basin. snow is the source of most of the river water flowing into the lower basin states of arizona, nevada and california. water levels in the river and lakes near yuma may fluctuate slightly throughout the summer, hendrix said. blocks of water are released upriver periodically as water orders come in from entities such as the yuma county water users association and the imperial irrigation district, hendrix explained. “ what we try to do is time the water deliveries to when they need the water down here. it wouldn ' t make a whole lot of sense to release a big block of water when it is not needed. we try to time it so it is put to its optimal use. ” “ we keep a fairly consistent level in the staging reservoirs on the way down, but you will see some fluctuation in the river as we bring water down this far to senator ' s wash or lake martinez. ” water users needn ' t worry about not having enough. with precipitation at 110 percent of average in the areas that fed the river in the winter of 2010 - 2011, plenty of water remains stored in reservoirs to meet the needs of municipalities and farmers all the way down to the yuma area, hendrix said. the lower colorado river is no stranger to drought, as it has experienced such conditions for over a decade. “ we went through roughly 12 consecutive years of drought and last year was one year out of many that we had above - average precipitation levels, ” hendrix said. “ it helped recharge the system somewhat, but when you ' ve had 11 years behind that which were consecutively drier than average, it is going to take some time to recharge the system. ” at current levels, and if drought conditions occur in the future, there is about three years worth of water left, hendrix noted. “ if we continue to have below - average precipitation beyond 2017 - 2018, we could start


a photo glimpse of the congo as head of the zoological society of milwaukee ’ s bonobo & congo biodiversity initiative ( bcbi ), dr. gay e. reinartz spends nearly six months each year in africa ’ s democratic republic of congo. during her october - december 2009 field season, dr. reinartz and the bcbi team visited the zoological society ’ s research station, etate, in salonga national park. ( dr. reinartz kept a field diary about her trip. ) they trained new congolese employees and delivered supplies. other accomplishments included : - the bcbi team delivered seeds and farming tools to several local villages neighboring the salonga national park for the agriculture cooperative that bcbi started and now helps run. an agriculture consultant who partners with the zsm checked on the villagers ’ progress. in addition to rice, beans and manioc ( a starch ), the villagers will try to grow soybeans in 2010. growing their own crops helps local residents to avoid poaching animals for food. - the bcbi team also delivered supplies and provisions for guards who live at etate year - round. - two new bcbi student teachers came to etate to help teach biomonitoring techniques to park guards. see this for more on the teacher trainees. - the primary schools at three villages supported by the zoological society received textbooks, pencils and other materials. for more on the schools and the farming cooperative, click here. - dr. reinartz and the bcbi team met with a group of parents whose children attend the schools. the parent committee was given money to pay teacher salaries. - the field team found bonobo nests in the forest. they also discovered poaching camps and evidence of elephant poaching. contributors to this slide show were dr. gay e. reinartz ( who provided the photos ), shawna joachim and julia kolker.


posted : dec 20, 2012 10 : 00 am by robert preidt thursday, dec. 20 ( healthday news ) - - researchers who discovered that some supposedly random gene mutations are not quite so random after all say their findings offer clues to the causes of autism and other disorders. the international team of scientists sequenced the complete genomes of identical twins with autism and their parents and found that the dna sequence in some regions of the human genome is quite unstable and can mutate 10 times more frequently than the rest of the genome. genes that are linked to autism and a number of other disorders have a particularly strong tendency to mutate, according to the study published dec. 21 in the journal cell. " our findings provide some insights into the underlying basis of autism - - that, surprisingly, the genome is not shy about tinkering with its important genes. to the contrary, disease - causing genes tend to be hypermutable, " principal investigator jonathan sebat, a professor of psychiatry and cellular and molecule medicine at the university of california, san diego, said in a university news release. an average of 60 mutations were detected in each child in the study, according to the report. " the total number of mutations that we found was not surprising, it ' s exactly what we would expect based on the normal human mutation rate, " said sebat, chief of the beyster center for molecular genomics of neuropsychiatric diseases at ucsd. however, he and his colleagues were surprised to find that mutations tended to cluster in certain regions of the genome. " we plan to focus on these mutation hotspots in our future studies, " sebat said. " sequencing these regions in larger numbers of patients could enable us to identify more of the genetic risk factors for autism. " the u. s. national institute of neurological disorders and stroke has more about autism. source : university of california, san diego, news release, dec. 20, 2012 copyright ( c ) 2012 healthday. all rights reserved.


| | | | | book brief | the history of modern science : a guide to the second scientific revolution, 1800 - 1950. stephen g. brush. iowa state univ. press ( 1988 ). isbn 0 - 8138 - 0883 - 9. $ 41. 95 cloth. comprehensive. brush has assembled a comprehensive guide to studying major developments in science from roughly the emergence of professional scientists ( around the turn of the 19th century ) to well into this century. during this period, the mechanistic, deterministic world view introduced by newton, descartes, boyle ( etc. ) in the " first " scientific revolution, was gradually undermined by discoveries in thermodynamics, evolutionary biology, psychology and nuclear physics. brush calls this the second scientific revolution. the volume is fashioned mostly for someone organizing a history of science course, but its contents and organization make it indispensable for the teacher serious about understanding the origins of modern scientific concepts and for reading about them more fully from high - quality sources. in fact, as the subtitle suggests, it is more a guide than an authentic history. the history is provided in brief synopses, designed to make sense of developments in a particular field or around certain key concepts. brush covers the ground very fast. these sketches are the framework for the primary emphasis : an extensive listing of specific historical sources. brush kindly addresses the non - specialist by focusing on books and periodicals that are more widely available and easily readable. also, this is a book more in essay format, useful for longer - term organizing and planning : do not expect the index to give you information and ready references to use in class the next day. the book is decidedly selective in the topics it addresses - - omitting, for example, the histories of the periodic table and of cell theory ( which are readily available elsewhere ). the main strength of the book, however, is precisely this alternative organization. brush emphasizes what gerald holton has called themata - - general concepts that permeate numerous fields : concepts such as atomism ( reduction into particulate units ), evolution ( dynamic unfolding ), randomness ( or indeterminism ), and energy ( a " kinetic worldview " ). as described and organized by brush ( see esp. the 14 - page survey in chap. 1 ), these themata form important interdisciplinary threads. for example, they help place anthropology, psychology and statistics, say, in the conventional contexts of chemistry, astronomy and pale


brush ( see esp. the 14 - page survey in chap. 1 ), these themata form important interdisciplinary threads. for example, they help place anthropology, psychology and statistics, say, in the conventional contexts of chemistry, astronomy and paleontology. departments trying to develop a program that integrates their biology, chemistry, physics and earth science classes will find many valuable clues here. the themata are also important to general history teachers, who will find the origins of significant social ideas - - say, about the origin of man and cultures ; the physical nature of the mind ; or the modern role of quantification. the chapters are organized to highlight these themes, and are worth listing here : evolution ; evolution of races and cultures ; gender and genetics ; freud and psychoanalyis ; behavior and intelligence ; atoms, energy and statistics ; electromagnetism and relativity ; atomic structure ; the explosion of physics ; and astronomy in the 19th and 20th centuries, respectively. as the chapter titles indicate, brush makes occasional excursions into several significant sub - topics, such as the history of the iq test, science and politics after the bomb, and questions of gender in science. the volume is largely an annotated outline. nevertheless, brush also comments on the ways we think about the past. he carefully exposes common prejudices about history - - and, indeed, about many scientific theories. he also devotes one chapter to philosophical and social perspectives, giving the novice a whirlwind tour of the variety of approaches now used to viewing the practice of science. | ships helps teachers share resources for integrating history, philosophy and sociology in the science classroom. e - mail us at firstname. lastname @ example. org for our quarterly news. | | |


fact sheet series 2004 - adult basic and literacy education the ovae fact sheet series highlights efforts currently underway at the office of vocational and adult education ( ovae ) to support the principles of the president ' s no child left behind act of 2001. the principle ( s ) supported by this effort are : - increase options and involvement for parents and students - increase flexibility and reduce bureaucracy - focus on what works the 1992 national adult literacy survey estimates that tens of millions of adults could benefit from adult basic education services. only a fraction of these individuals are actually enrolled in classroom programs. in the interest of providing more learning options to adults, fourteen states have formed a consortium to explore the potential of teaching adults with limited skills using web - based and technology - facilitated distance learning. ovae has funded a portion of project improving distance education for adult learners ( ideal ) to focus on national issues related to assessment, accountability, and teacher training. project ideal is directed by the university of michigan and is a partnership of fourteen states ( ar, id, il, ky, ma, me, m o, nc, ny, oh, pa, ri, wa, and wv ). these states are participating in separate state funded " experiments " to explore the possibilities of using technology - enabled and / or web - enhanced distance education to deliver instruction to adult learners who choose not to attend classroom based programs. their work has pointed to several common needs among states including how to report data to the federal office for distance learners. federal funds are being provided through project ideal to explore strategies appropriate to measure educational progress when adults are learning in non - classroom settings using technology - based interventions. the project also supports teacher quality in distance learning through the creation of teacher training materials that may be used by the states. outcomes and products - on - line course to prepare teachers of distance learning - published reports on assessment issues in distance education for adult learners and accountability issues in distance education for adult learners - course study guide and trainer guide to accompany on - line materials - additional resources and improved data to state and local providers on delivering quality instruction at a distance


paralegals are trained specialists who, under the supervision of an attorney, perform a wide variety of legal tasks. these tasks may include legalresearch, law office management and preparation of legal documents. only an attorney may provide legal services directly to the public. students canearn the associate in applied science which prepares graduates for employment in law offices, corporate legal departments, legal services corporations, state government offices, title companies and federal and state courts. students who have already earned an a. a., a. s., a. a. s., b. a. or b. s. degree canearn the certificate. students with one of these degrees plus three years of full - time paralegal work experience can earn the certificate of achievement. can students who major in paralegal studies transfer to a four - year college or university? many colleges and universities will apply the courses taken toward a bachelor ’ s degree. are there any requirements that must be satisfied before taking courses in the major? students must either have a high school diploma or have passed an equivalency examination. algebra i is a prerequisite for all majors. algebra i competency must be verified with a passing score on the college ’ s placement test. how long will it take to complete this degree? students who do not need developmental coursework can complete the degree in two years or the certificate in three semesters. they can shorten the amount of time by taking courses in the summer and winter sessions. what are the objectives of this program? 1. provide a strong, flexible program for the quality education of the occupationally competent paralegal. 2. provide a paralegal education program that leads to the opportunity for employment of its graduates by a wide range of employers. 3. provide paralegals with a well - rounded, balanced education founded on a beneficial mix of general education, theory, and practical courses, stressing understanding and reasoning rather than rote learning of facts. 4. support the general principle of ethical legal practice, professional responsibility and the prohibitions against the unauthorized practice of law by non - lawyers. 5. provide an educational program that is responsive to the needs of the state of new jersey and contributes to the advancement of legal professionals. 6. provide a program that instills respect for the legal profession and its foundations, institutions, and quest for justice. 7. maintain equality of opportunity in the educational program without discrimination or segregation on the grounds of race, color, religion, national origin or sex. the program


instills respect for the legal profession and its foundations, institutions, and quest for justice. 7. maintain equality of opportunity in the educational program without discrimination or segregation on the grounds of race, color, religion, national origin or sex. the program ’ s overall objective is to provide quality education for paralegals so that they might assist the legal profession in rendering more personal, economical services to a greater number of persons. how are these objectives met? 1. through flexible curriculum planning which stresses a balance among general education courses, law related courses, legal specialty courses, and electives. 2. through continual assessment of the need for the program as evidenced by the legal profession ’ s response to regular surveys and the ability of the program to place graduates. 3. by keeping the enrollment of the program to a size that will ensure a good student - teacher ratio and give graduates a good chance for paralegal employment. this is determined in the same method as number 2 above. 4. by providing the program with a well qualified full - time director with the necessary time to devote to the extensive administrative duties of the position. when students complete the program, what skills will they have? 1. use the law library, including encyclopedias, reporter systems, digests, and practice manuals, including updating sources ; utilize computer - assisted research including westlaw, reporter systems, statutes, administrative codes, updating sources and extended databases. 2. understand and use rules governing courts and basic litigation procedures including telephone technique, client interviews, complaints, interrogatories, and motions. 3. use forms and filing procedures relevant to typical legal proceedings. 4. use forms and filing procedures in real and personal property transactions, including real estate settlement procedures act. note : for students matriculating in this program, degree credit will not ordinarily be given for any course designated pls which was completed more than six years prior to completion of the degree program.


genre : realistic fiction age level : 14 and up # of pages : 184 rac book : yes awards : iowa high school award winner 2009 - 2010 this book follows three different perspectives : alex, clinton, and daria. alex is a new student in a small town school where everyone knows he is hiv positive. at the beginning of the story he is attacked in his car by a baseball bat. the attacker breaks the windshield so that he is cut by the glass. daria, a student with down syndrome, is the only witness and believes the assailant to be clinton cole. clinton has made it known that he is afraid of catching aids and wants alex to leave the school, but swears he did not do this crime. did clinton do this and if he did not will he be punished anyway? the three perspectives in this book help the reader to understand where each character is coming from. as the three perspectives follow the events after the attack it becomes clear that alex and clinton both have many issues they are dealing with at home and at school. some of the issues they deal with at school are fear, guilt, and a desire to fit in and be “ normal. ” at home they find that they want to please their parents without allowing them too much control over their lives. this book emphasizes how difficult it is to be a teenager and be different in any way. teenagers are always wondering what if their friends are real friends and would stand by them during difficult times and these three people are disappointed by what they find. this would be a great story for any high school student to read because it helps them think about situations from other people ’ s perspectives. it also helps them realize that everyone feels self conscious about something and that people are more aware of what people say about them than those who say mean things realize. also recommended are alex flinn ’ s books breathing underwater and diva.


| code : 302397 | | date : 2012 / 03 / 13 - 14 : 14 | | source : islamicinsights | islamic principles on establishing peaceful religious coexistence shaikh mansour leghaei ( ahlul bayt news agency ) - in order to establish peaceful religious coexistence in society, islam has suggested four principles. no compulsion in religion no doubt there are different factors involved in forming people ' s opinions and faiths. the physical structure and the organic compounds, time, place, diet, education, and so many other factors have inevitable effects on people ' s faiths. thus, the healthy way to change their opinion is to encounter them from their origins. utilizing force and compulsion not only cannot change the hearts of people, but it may in many instances increase hatred and animosity. to this end, the holy qur ' an clearly denounces the use of the force in terms of religion. it is ultimately the right of people to choose any religion they are happy with, and the duty of the prophets is not more than educating people and reminding them of the right path. they have never been authorized to force people to the truth. the following verses are the examples of many : " let there be no compulsion in religion ; truth stands clear from error. " ( 2 : 256 ) " if it had been the lord ' s will, all who are on earth would have believed. will you then compel mankind against their will to believe?! " ( 10 : 99 ) " say, the truth is from your lord, let him who will believe, and let him who will reject. " ( 18 : 29 ) " and you are not the one to overawe them. therefore, remind with this qur ' an those who reverence my warnings. " ( 50 : 45 ) " you shall remind, for you are the reminder. you are not one to manage ( men ' s ) affairs. " ( 88 : 21 - 22 ) " enlightenment has come to you from your lord. as for those who can see, they do so for their own good, and those who turn blind, do so to their own detriment. i am not your guardian. " ( 6 : 104 ) " if they reject you, then say : ' my work to me and yours to you. you are free from the responsibility of what i do and i for what you do. ' " ( 10 : 41 ) " the sole duty of the messenger is to deliver the message, and


say : ' my work to me and yours to you. you are free from the responsibility of what i do and i for what you do. ' " ( 10 : 41 ) " the sole duty of the messenger is to deliver the message, and allah knows everything you declare and everything you conceal. " ( 5 : 99 ) " if they argue with you, then say i have simply submitted myself to god ; i and those who follow me. and you shall proclaim to those who received the scripture as well as those who did not, ' would you submit '? if they submit then they have been guided, but if they turn away, your sole mission is to deliver this message. god is seer of all people. " ( 3 : 20 ) " you shall obey god and you shall obey the messenger, and beware if you turn away, then know that the sole duty of our messenger is to deliver the message efficiently. " ( 5 : 92 ) the above verses utterly denounce the practice of inquisition and pressuring the followers of other religions in order to change their beliefs. nevertheless, preaching and enlightening people is permitted and is the duty of the messengers in a logical manner. logical debate and discussion while respecting other religions and beliefs, islam may disagree with some of their teachings, finding them illogical, and hence invites their adherents to open discussion and debate in a peaceful and logical manner far from any type of fanaticism and prejudice. the following verses are the examples of this approach : " and dispute you not with the people of the book except with means better ( than mere disputation ) unless it be with those of them who inflict wrong. but say, ' we believe in the revelation which has come down to us and in that which came down to you, our god and your god is one, and it is to him we submit. ' " ( 29 : 46 ) " invite all to the way of your lord with wisdom and beautiful preaching, and argue with them in ways that are best and most gracious. " ( 16 : 125 ) " so announce the good news to my servants, those who listen to the word and follow the best of it. those are the ones whom allah has guided and those are the ones endued with understanding. " ( 39 : 17 - 18 ) " say : produce your proof if you are truthful. " ( 2 : 111, 21 : 24, 16 : 64, 9 : 6 ) divine religions : grades of one school judaism, christianity,


. " ( 39 : 17 - 18 ) " say : produce your proof if you are truthful. " ( 2 : 111, 21 : 24, 16 : 64, 9 : 6 ) divine religions : grades of one school judaism, christianity, and islam have a great deal in common. they are all based on monotheism and are committed to increasing justice in the world and the accountability before god. their historic roots go back to prophet abraham ( peace be upon him ), and as such, they are often described as ' abrahamic faiths '. they are also the basis of great world civilizations. therefore, despite the followers of other religions who consider themselves the chosen nation and the only saved ones, islam considers all of the divine religions as different grades of the one school. from the islamic point of view, each new divine religion has been the upgraded version of the previous one, prescribed to complete its teachings. all of the prophets are the teachers of one school, teaching different grades according to the requirements of the people of their age. hence, if hypothetically all of them descend to earth, they would live together peacefully and each would acknowledge his successor and the one who has come after him. an old debate has gone around among the followers of different religions as to who will go to hell and who to heaven. the followers of each religion with no hesitation claim eternal life in heaven for themselves, and see hell as the place for all who oppose them. islam, despite this fanaticism, suggests a very liberal idea. the following verses vividly reveal this idea. " they say : ' become jews or christians if you would be guided. ' say, ' nay! ( i would rather ) the religion of abraham, the true, and he joined no gods with allah. ' say, ' we believe in god, and in what was sent down to us, and in what was sent down to abraham, ismail, isaac, jacob, and the patriarchs ; and in what was given to moses and jesus, and all the prophets from their lord. we make no distinction among any of them. to him alone we are submitters. ' " ( 2 : 135 - 136 ) " and they say : ' none shall enter paradise unless he be a jew or a christian. ' those are their ( vain ) desires. say produce your proof if you are truthful. yes, whoever submits his whole self to allah and is a doer of good, he will get his reward with his lord, on such shall be no fear


are their ( vain ) desires. say produce your proof if you are truthful. yes, whoever submits his whole self to allah and is a doer of good, he will get his reward with his lord, on such shall be no fear, nor shall they grieve. " ( 2 : 111 - 112 ) " those who believe ( in islam ) and those who follow the jewish ( scriptures ) and the christians and the sabians, any who believe in allah and the last day and work righteousness, shall have their reward with their lord ; on them shall be no fear, nor shall they grieve. " ( 2 : 62 ) the principle of righteousness and justice the last suggestion prescribed by islam to achieve harmony among people of different cultures and religions is that islam has always advocated for the principle of justice and righteousness within humankind. muslims are encouraged to deal kindly and justly with all people, muslims and non - muslims alike, with the exception of those who are fighting muslims. the holy qur ' an revealing the above fact utters : " allah forbids you not, with regard to those who fight you not for your faith, nor drive you out of your homes, from dealing kindly and justly with them, for allah loves those who are just. " ( 60 : 8 )


- buy the book - about 1 / 3 of the world ’ s population is infected with latent tuberculosis infection. - most tb - affected populations are concentrated in poorer regions of the worlds. - new study explores whether substandard and falsified drugs may be exacerbating the problem of drug resistance. - curbing the manufacture & availability of falsified & substandard anti - tb drugs is necessary to protect public health. download pdf about a third of the world ' s population is infected with latent tuberculosis infection ( ltbi ). 1 individuals with latent infection have a 10 % lifetime risk of developing active tb, although the risk is greater for those whose immunity is impaired, often due to the human immunodeficiency virus ( hiv ). 1 the world health organization ( who ) estimates that there were 8. 8 million incident cases of tb and 1. 5 million tb deaths in 2010. 1 most tb - affected populations are concentrated in poorer regions of the world, and fatalities occur disproportionately in africa. 1 treatment for tb is long and complicated. 2 the who recommends that new patients with pulmonary tb begin treatment with a daily 2 - month intensive phase of isoniazid ( inh ), rifampicin ( rmp ), ethambutol and pyrazinamide, followed by a 4 - month continuation phase of inh and rmp. 3 if treatment is stopped too soon or administered intermittently, or if insufficient anti - tuberculosis drugs are taken as monotherapies, the remaining bacilli can become drug - resistant. 4 in resource - limited settings, drug resistance arising from poor treatment adherence is compounded by irregular drug supplies, medicines of inferior quality, lax prescription drug laws and weak enforcement of those laws that allows for the ready availability of monotherapies and fi xed - dose combinations ( fdcs ). 4 treatment for multidrug - resistant ( mdr - ) and extensively drug - resistant tb ( xdr - tb ) is significantly longer and more difficult for patients to complete, taking up to 2 years and requiring patients to ingest large numbers of pills. 5 mdr / xdr - tb can quickly become fatal, especially if a patient ' s immune system is compromised. 6 available data suggest that antimicrobials and antiparasitics are the two types of pharmaceutical products that are most counterfeited in developing countries. 7 substandard and falsified anti - malarial drugs have been found


compromised. 6 available data suggest that antimicrobials and antiparasitics are the two types of pharmaceutical products that are most counterfeited in developing countries. 7 substandard and falsified anti - malarial drugs have been found to be readily available in low - and middle - income countries. 8 little research has been conducted to assess levels of falsified and substandard tb drugs in developing countries outside some research on the degradation of fi xed - dosed combination therapies. 7, 9 – 12 in a pilot study assessing the quality of inh and rmp samples collected from the private sector in two indian cities, it was found that respectively 12 % and 9 % of samples failed either thin - layer chromatography ( tlc ) or a disintegration test, making them substandard. 13 the present study analyzes the quality of anti - tuberculosis drugs in the private sector in 17 low - and middle - income countries, and explores whether substandard and falsified drugs may be exacerbating the problem of drug resistance. treatment packs of two first - line anti - tuberculosis drugs ( n = 713 ) on the who model list of essential medicines, 14 rmp and inh, were collected from 19 cities in 17 low - and middle - income countries. following the methodology of previous studies, local nationals posing as customers purchased drugs from private sector pharmacies in middle - income areas of each city, selecting pharmacies on fi rst sight during an undirected walk within a single neighbourhood. 8, 15, 16 such an approach is referred to as convenience sampling, with an attempt to reduce bias in the selection of pharmacies from which drugs were procured. the covert shoppers were not informed about the purpose of the collection. as the pharmacists selling the products were taking part in normal business practice, ethical review was not required for the study. all samples were monotherapies purchased without a prescription. the purchased drugs were stored at ambient temperature with low humidity and no sunlight until testing. tests were completed within 40 days of sample collection. the minilab® ( global pharma health fund, giessen, germany ) was used to run semi - quantitative tlc on each sample to determine the presence and relative concentration of the active pharmaceutical ingredient ( api ), and whether it met internationally acceptable standards. in previous studies, tlc testing using the minilab protocol yielded broadly similar results to high - performance liquid chromatography when


to determine the presence and relative concentration of the active pharmaceutical ingredient ( api ), and whether it met internationally acceptable standards. in previous studies, tlc testing using the minilab protocol yielded broadly similar results to high - performance liquid chromatography when used to analyze pharmaceuticals. 17 laserson et al. showed that tlc is an effective method of detecting substandard anti - tuberculosis drugs. 10 the minilab protocols award products a ' pass ' for tlc if > 80 % of the api is present as mentioned on the label. disintegration tests were conducted to see if samples disintegrated in water at 37°c in < 30 min. products were labeled ' failures ' if they did not pass the most basic requirements of api concentration and solubility. in other words, even products that passed may have been of poor quality. each drug brand was checked against the official list of authorized products in the country in which it was procured. non - registered drugs are not necessarily inferior, but they are illegal, as they are not authorized to be sold in that country. test results were broken down by registration status once testing was complete to eliminate potential bias. failing products that contained at least 10 % of api were recorded, as, in the absence of data, the authors estimated that these products were likely to contribute to drug resistance. for the purpose of this study, ' falsified ' is defined as drugs that appeared to be deliberately and fraudulently mislabeled with regard to identity. whereas the term ' counterfeit ' has traditionally been used for this purpose, ' falsified ' reflects the latest terminology, as ' counterfeit ' is now more often used to refer specifically to products that display evidence of trademark infringement. 18 samples that appeared to be poorly manufactured or degraded were considered substandard. the table shows the number of failures by drug type and registration status. registered drugs were those that were authorized by the relevant drug regulatory authority in the country in which the drug was sold. overall, 9. 1 % ( 65 / 713 ) of the drugs sampled failed basic quality control tests. the failure rate was 16. 6 % in africa, 10. 1 % in india and 3. 9 % in other middle - income countries. the failure rate was 28. 6 % for non - registered products and 4. 4 % for registered products. however, even registered products exhibited some quality problems in all of the regions studied. the higher failure rate in africa may be explained by the fact that fewer products are registered


. 6 % for non - registered products and 4. 4 % for registered products. however, even registered products exhibited some quality problems in all of the regions studied. the higher failure rate in africa may be explained by the fact that fewer products are registered in africa ; consequently, more failures are caused by the greater number of illicit products on the market. africa also has the highest percentage of failing products with non - trivial amounts of api ( 70. 4 % ), compared to 51. 9 % in india and 27. 3 % in other middle - income countries. these products are most likely to be degraded or poorly manufactured ( substandard ) rather than falsified. of the 25 properly registered ' failures ', 11 ( 44 % ) appeared to be falsified, as they either contained no api or had suspect packaging. of the non - registered product failures, 7 / 40 ( 17. 5 % ) appeared to be falsified. this figure is conservative, as other products with low levels of api ( but > 0 % ) may also have been falsified. as dissolution testing was not conducted in this study, these figures may in fact underestimate the problem, particularly for rmp, which often exhibits solubility problems when poorly manufactured. 19 it is not always possible to discern why a drug fails quality control. none of the ' failures ' had too much api. in addition to poorly formulated drugs, some of the under - dosed products may have been properly manufactured but lost api due to degradation in poor storage conditions. although it is impossible to be certain, it is likely that 44 % of the properly registered ' failures ' were falsified, as they contained no active ingredient or had suspect packaging. while product packaging was visually inspected for correctness, comparison with reference samples was not always feasible, as attempts to collect such samples from manufacturers were unsuccessful — some manufacturers will only share information with large customers and regulators. an additional 17. 5 % of non - registered ' failures ' appeared to be falsified for the same reasons, and others with low levels of api may also have been falsified. these products can cause physical harm to patients and economic damage to the companies whose products they imitate. even if they contain no active ingredient, they can cause increased resistance to the other drugs with which they are taken in combination. most of the ' failures ' were not properly registered. by and large, even poor quality, non - registered products were made by legitimate manufacturers — which were often licensed in at least


increased resistance to the other drugs with which they are taken in combination. most of the ' failures ' were not properly registered. by and large, even poor quality, non - registered products were made by legitimate manufacturers — which were often licensed in at least one country. medicines produced by legitimate manufacturers with insufficient api or improper solubility constituted a proportionately larger share of drug failures than falsified samples. while these drugs may work in some cases, the insufficient api dose may prevent patients ' chances of cure and contribute to drug resistance. these results are limited to the private sector and did not include samples procured from national tb programs. while tb is typically viewed as a public health issue, wells et al. showed that large numbers of patients seek treatment for tb in the private sector. 20 moreover, if drug resistance spreads as a result of poor quality anti - tuberculosis drugs in the private sector, both public and private sector patients will suffer. there is a need for the who to conduct larger studies to determine the full extent of the availability of substandard and counterfeit anti - tuberculosis drugs and to provide clear, consistent and useful defi nitions of each of the above terms. seear et al. ' s definition for counterfeit drugs includes only those drugs with 0 % api, 21 which is too narrow, as some counterfeit manufacturers fake versions of drugs through a ' second shift ' at what are otherwise legitimate manufacturing sites, with some — but intentionally insufficient — levels of api. 22 lessons from the malaria community the malaria community started paying attention to the dangers of falsified and substandard drugs in the 1990s, and the tb community needs to catch up. substandard or falsified antimalarial drugs may indirectly cause the death of a child within 48 h of disease onset. 23 however, this tragic fact means that strains of malaria have less time and fewer opportunities to develop resistance. as tb is less acutely fatal than malaria, patients taking under - dosed anti - tuberculosis drugs may temporarily feel better, but if the drug does not eliminate the bacilli, resistance may develop. this may also extend the required treatment time, increasing both the cost of treatment and the risk of developing resistance. in 2011, physicians in mumbai made headlines when they reported multiple cases of tb for which they could identify no successful medicinal treatment. 24 as the drugs used to treat mdr / xdr - tb are more expensive and less effective than the first - line drugs, 25 it is vital to preserve the efficacy of first - line treatment.


which they could identify no successful medicinal treatment. 24 as the drugs used to treat mdr / xdr - tb are more expensive and less effective than the first - line drugs, 25 it is vital to preserve the efficacy of first - line treatment. we also need new anti - tuberculosis drugs that will reduce treatment duration and provide alternative treatments for patients with drug - resistant tb. a significantly shortened treatment regimen would reduce the risk of developing drug resistance. 26 the government of india pays close attention to ensuring that low - cost anti - tuberculosis drugs can be accessed by the poor, both in india and throughout the developing world. this is indeed important ; treatment interruptions due to the inability to pay for drugs may be as damaging as providing patients with underdosed drugs, and may equally contribute to drug resistance. these two problems are not antagonistic to each other ; they must be tackled simultaneously with all means available. expanding access to anti - tuberculosis drugs without addressing quality concerns could create a massive drug resistance crisis. increasing resistance will cause a small increase in patient deaths in the short term, but will be extremely deadly and costly to patients, and increase costs and complications for health providers alike in the long run. in this preliminary analysis, 9. 1 % ( 65 / 713 ) of the inh and rmp samples tested failed quality control tests. approximately half of these failing products ( 36 / 65, 55. 4 % ), or 5 % of the total, had api > 0 %, making them likely to contribute to drug resistance. the tb community needs to pay greater attention to preventing the proliferation of falsified and substandard anti - tuberculosis drugs. governments — especially those with high tb burdens — should improve the regulators ' capacity to remove drug manufacturers that repeatedly fail quality control testing from government tenders, and they should use law enforcement mechanisms, such as interpol ' s medical product counterfeiting and pharmaceutical crime unit, to disrupt the illicit trade in falsified drugs. curbing the manufacture and availability of falsified and substandard anti - tuberculosis drugs is necessary both to protect the public health and to safeguard the efficacy of existing drugs — above all the cheap, effective firstline drugs.


editor ’ s note : we haven ’ t normally been posting these news releases on the afhs blog but this was just too good to pass up. enjoy! the final, missing column of data from the 1911 census, which details individuals ’ infirmities is today released for the very first time at www. findmypast. co. uk and www. 1911census. co. uk, the family history websites which first launched the 1911 census three years ago in 2009 in association with the national archives. the infirmity column details wide - ranging descriptions of peoples ’ health conditions as perceived and hand - written by the head of the household on the night of sunday 2 april 1911. under data protection regulations, this sensitive information has remained closed until now. a less ‘ politically correct ’ society ‘ lunatic ’, ‘ imbecile ’ and ‘ feeble - minded ’ are some of the most commonly used entries reflecting an era before such terminology was deemed unacceptable. the census in fact prompts the respondent to record if a person is ‘ totally deaf ’, ‘ deaf and dumb ’, ‘ totally blind ’, ‘ lunatic ’, ‘ imbecile ’ or ‘ feeble - minded. ’ 5 most common ‘ infermities ’ recorded in 1911 - deaf and dumb however, not all the entries are negative or insensitive. the 1911 records also reflect the humour and curious family dynamics from a century ago – not too dissimilar to what we know now in 2012. one extraordinary record details a mr john underwood from hastings recording his children as ‘ quarrelsome ’, ‘ stubborn ’, ‘ greedy ’, ‘ vain ’ and ‘ noisy ’. he even records himself as ‘ bad - tempered ’ and his wife as suffering from a ‘ long tongue ’. another unusual entry is from thomas wallace young, who was described as being ‘ bald and toothless ’, helping us picture exactly what he looked like. william robert arnold from yorkshire commented on his financial status in 1911 by recording his infirmity as being ‘ short of cash ’. suffragette labels ‘ voteless ’ as her infirmity the cause of the suffragettes is also illustrated within the new records, with some women listing their infirmities as not having the vote or not being enfranchised. for example, four women living in the same household recorded their infirmities as ‘ voteless, therefore classed with idiots and children ’. infirmities? ‘ none, thank god ’ some chose to make a note of their good health instead


. for example, four women living in the same household recorded their infirmities as ‘ voteless, therefore classed with idiots and children ’. infirmities? ‘ none, thank god ’ some chose to make a note of their good health instead of the health problems the form enquired about, such as ‘ well ’, ‘ healthy ’, ‘ sane ’, ‘ alright ’ and even ‘ perfect ’. evelyn baker and her family from leeds were recorded in the census by their father addiman parkin barker as simply being ‘ alive ’. seventy - two entries simply say ‘ none, thank god ’. 10 unusual infirmities in the records - bald and toothless - short of cash - bad tempered - long tongue connections between infirmity and profession a correlation between infirmity and occupation can also be identified in some cases. the biggest source of employment for blind men and women was basket - weaving. other trades for blind men were musicians or musical instrument makers. women who were ‘ deaf and dumb ’ were often employed within the textile or garment trades, or in domestic service, while men were most likely to be labourers. debra chatfield, family historian at findmypast. co. uk, said : “ the infirmities column is the last piece of the jigsaw completing the 1911 census. this column alone provides a fascinating insight into life a hundred years ago. it not only reflects health conditions, but also a time before society became aware of political - correctness and certain terminology was deemed acceptable. in the more unusual entries we also get a wonderful sense of post - edwardian humour, society and family dynamics at this time. “ researching your family history is a fascinating way to learn about your ancestors. the 1911 census records include detail about occupations, housing arrangements and social status and you are also able to see a copy of the handwritten record itself. ” audrey collins, family history records specialist at the national archives, said : “ the information in the ‘ infirmities ’ column being released today helps add an extra dimension to the picture of our ancestors ’ lives in 1911. we have to remember that the census returns were completed by relatives living in the same house who for the most part had no specialist medical knowledge. their descriptions provide us with a clue as to how each individual was viewed by other family members, although many would have been reluctant to admit that their relatives suffered from any defect. ”


diagnosis and treatment of sexually transmitted infections i. definition of the prevention area sexually transmitted infections ( stis ) likely facilitate hiv transmission and acquisition. sti treatment efforts have been used as an hiv prevention approach with mixed outcomes. this prevention strategy may be most effective in settings with a high burden of stis and when targeted to most - at - risk populations and their sexual partners. however, randomized trials have found sti treatment to have little to no effect on hiv incidence. ii. epidemiological justification for the prevention area the role of stis in the transmission dynamics of hiv epidemics is paradoxical and complex. population - based studies have found that both the prevalence and incidence of hiv were substantially higher in people with stis. both curable stis and chronic infections such as herpes simplex virus type - 2 ( genital herpes ) can increase vulnerability to hiv infection by disrupting skin and mucosal barriers and / or by causing inflammation that brings hiv - susceptible immune cells to the genital tract. stis are biological markers for risky sexual behaviors, which are also risk factors for hiv acquisition. in addition, a number of studies in hiv serodiscordant couples report that hiv - positive individuals with herpes or genital ulcer disease are significantly more likely to transmit hiv to their partners. some stis appear to increase the risk of hiv transmission by boosting viral shedding in the genital secretions of both men and women who are hiv - positive. other studies of hiv - positive individuals on antiretroviral therapy suggest that stis may increase the infectiousness of hiv, even when an individual has an undetectable viral load. despite these data, numerous clinical trials have not been able to demonstrate a decline in hiv incidence as a result of sti treatment. some hypothesize that treated stis may still cause inflammation and other changes in the genital mucosa even after the initial symptoms have disappeared. the ongoing inflammation and changes in the genital mucosa may be why sti treatment does not have an effect on hiv incidence. epidemic stage, prevalence of viral versus bacterial stis, and type of treatment may also be reasons that sti treatment does not lower hiv incidence. iii. core programmatic components while sti treatment does not seem to have a significant impact on hiv incidence, effective management of stis is an essential public health activity and is particularly important for improved maternal and child health outcomes. data linking the prevalence of stis with increased risk of hiv transmission and acquisition


does not seem to have a significant impact on hiv incidence, effective management of stis is an essential public health activity and is particularly important for improved maternal and child health outcomes. data linking the prevalence of stis with increased risk of hiv transmission and acquisition underscore the importance of sti prevention, which can best be achieved through a comprehensive sti control program. the u. s. president ' s emergency plan for aids relief ( pepfar ) supports sti control for hiv prevention depending on epidemic type and population. in concentrated epidemics, the population focus should be on most - at - risk populations, individuals with symptomatic stis, hiv - positive persons with high - risk behaviors, and other groups that may be at high risk for sti acquisition. in generalized epidemics, pepfar supports sti control programs for high - risk subpopulations, including most - at - risk populations, individuals with symptomatic stis, hiv - positive persons, and sexually active adolescents. pepfar also supports hiv testing and counseling services for sti patients. a 2009 review of sti control and hiv prevention in the bulletin of the world health organization concluded that the core elements of a comprehensive sti control program should include : - reaching out to populations at greatest risk, particularly those who change partners frequently, potentially propelling transmission within the population - promoting safer sex through the provision of condoms and other prevention activities - offering effective clinical interventions ( including sti screening, treatment, and case management ) - initiating structural interventions to ensure an environment that supports safer sex behavior and care - and treatment - seeking behaviors - collecting reliable data to monitor disease trends and the effectiveness of interventions. iv. current status of implementation experience research is ongoing to better understand how stis modify hiv transmission. the development of improved screening strategies to detect some asymptomatic stis in resource - limited settings remains a research priority. currently, sti treatment as a stand - alone hiv prevention intervention in generalized epidemics is not supported by scientific data. sti control for hiv prevention depends on the type of hiv epidemic and the populations at highest risk. a number of resource - limited countries, including cambodia, kenya, senegal, sri lanka, and thailand, have demonstrated that it is feasible for programs to expand sti control services. several countries that have successfully controlled stis have also reported stabilization or reversal of their hiv epidemics. for instance, in india, the avahan initiative reported a reduction in sti and hiv incidence after it included the improved delivery of sti


services. several countries that have successfully controlled stis have also reported stabilization or reversal of their hiv epidemics. for instance, in india, the avahan initiative reported a reduction in sti and hiv incidence after it included the improved delivery of sti management to most - at - risk groups as part of its comprehensive prevention interventions. thailand ' s 100 % condom program appears to have contributed to both sti reduction and hiv prevention by requiring condom use in brothels. sti screening, management, and treatment are key components of the pepfar comprehensive package of services for most - at - risk populations. the review examines the role that sexually transmitted infections ( stis ) play in people living with hiv and how the co - infections of stis and hiv play on the prevention potential of antiretroviral therapy ( art ) in limiting hiv transmission rates. the search includes studies that report on stis in people living with hiv and were published from 2000 to 2010. it also only includes stis that demonstrate hiv shedding in the genital tract such as syphilis, chancroid, and gonorrhea. thirty - seven studies are presented in the review, and it was found that the overall mean point prevalence of sti co - infection was 16. 3 percent. the most common stis co - infections were syphilis, gonorrhea, chlamydia, and trichomoniasis. the highest prevalence of sti / hiv co - infections were in people newly diagnosed with hiv, but sti co - infections take place throughout the course of hiv infection and not only when first diagnosed. for example, the average sti / hiv co - infections was 14 percent. people taking art also were diagnosed with sti co - infections to a high degree, and there was not a significant difference of co - infections between hiv - positive individuals who were or were not on art. the review points to limitations to forecast data on the overall effect of art for prevention programs on reducing transmission rates in hiv epidemics. they often do not include the effect of sti co - infections in the models, which would reduce the successfulness of those results. sti co - infections should be included in future models and forecast when considering art as a prevention strategy. treatment of curable sexually transmitted infections ( stis ), a relatively inexpensive, simple, and effective intervention, should be promoted as an essential component of hiv control programs in communities with a high incidence of stis. the authors derived this from reviewing the observational studies and


sexually transmitted infections ( stis ), a relatively inexpensive, simple, and effective intervention, should be promoted as an essential component of hiv control programs in communities with a high incidence of stis. the authors derived this from reviewing the observational studies and nine randomized controlled trials ( rcts ) evaluating the impact of sti treatment interventions on hiv incidence. although only one of nine rcts has demonstrated an effect on hiv incidence, the authors conclude that issues in trial design and conduct - - including hiv epidemic phase, sti prevalence, and intervention in comparison groups - - affected several of the trials. the rcts examined three different management approaches to a broad spectrum of curable and incurable stis in varying populations, with different levels of risk behaviors and sti prevalence, in both concentrated and generalized hiv epidemic settings. four of the trials focused on population - level effects of sti treatments, with only one focusing on populations with high sti prevalence. three trials, focusing on herpes suppressive therapy, found that antivirals for herpes simplex virus suppression were insufficient to control the cofactor effect of herpes simplex virus type - 2 on hiv transmission. the authors advocate for future research examining the biological mechanisms responsible for the sti - hiv interactions, testing new sti control strategies that target these interactions, and developing point - of - care sti diagnostics and evaluation of alternative partners service approaches ( e. g., patient - delivered partner therapy ). this randomized, placebo - controlled clinical trial of acyclovir set out to determine whether or not the drug could reduce the transmission of hiv from partners co - infected with hiv and herpes simplex virus type - 2 ( hsv - 2 ) to their serodiscordant partners. the study was conducted among over 3, 400 serodiscordant couples in 14 sites in southern and eastern africa. although daily therapy with acyclovir reduced mean plasma concentrations of hiv and the occurrence of genital ulcers due to hsv - 2, it did not cut the risk of hiv transmission, the study found. however, it proved the feasibility of conducting trials among hiv serodiscordant couples. this study used confidential computerized interviews to ask people living with hiv about recent history of sexually transmitted infections ( stis ) as well as their sexual behaviors and infectiousness beliefs. it found that one in seven respondents had been diagnosed with an sti over a six - month period, most commonly herpes simplex virus and syphi


of sexually transmitted infections ( stis ) as well as their sexual behaviors and infectiousness beliefs. it found that one in seven respondents had been diagnosed with an sti over a six - month period, most commonly herpes simplex virus and syphilis. there was a strong association between belief that viral load was undetectable and diagnosis with an sti. the authors advocate integration of sti diagnosis and treatment into routine clinical hiv care. it is also crucial to correct false beliefs about infectiousness and provide education about sti symptom recognition and the importance of early detection and aggressive treatment, they write. the joint united nations programme on hiv / aids mode of transmission model spreadsheet was used to assess the impact of various hiv prevention interventions based on data available from malawi, taking into account the country ' s high prevalence of partner concurrency and serodiscordancy. interventions in the model include increased condom use, more circumcisions, and converting all multiple concurrent partnerships into monogamous partnerships. the model showed that most new cases were among low - risk heterosexual groups ( i. e., those who were part of serodiscordant couples or those who had casual sex and their partners ). condom use by discordant couples, a monogamy policy such as uganda ' s zero grazing campaign, and abstinence were the most effective prevention measures ; improved treatment of sexually transmitted infections had only a limited effect. the prevalence and incidence of reproductive tract infections ( rtis ) and hiv over a five - year period and the relationship between rtis and hiv infection were examined in this study of more than 4, 400 women attending family planning clinics in zimbabwe and uganda. even though the women received regular counseling on risk reduction, screening, and treatment for rtis, the incidence of hiv and rtis did not diminish during the study period and almost all types of rti were associated with increased risk of hiv infection. the authors still conclude that aggressive efforts to control rtis may contribute significantly to hiv prevention and recommend continued efforts to find more effective treatments and interventions. this small study offers an explanation for why treating herpes simplex virus type - 2 ( hsv - 2 ) does not lead to a reduction in hiv acquisition even though infection with hsv - 2 is associated with increased risk of hiv infection. examining biopsies from eight subjects infected with hsv - 2, the authors found that below healed herpes lesions, there is profound localized inflammation that persists even after prolonged antiviral therapy. future


is associated with increased risk of hiv infection. examining biopsies from eight subjects infected with hsv - 2, the authors found that below healed herpes lesions, there is profound localized inflammation that persists even after prolonged antiviral therapy. future interventions to break the association between hsv - 2 and hiv should strive to reduce this inflammation or lead to the development of a hsv - 2 vaccine, the authors conclude. this randomized, double - blind, placebo - controlled trial enrolled hiv - negative, herpes simplex virus type 2 ( hsv - 2 ) seropositive women in africa and men who have sex with men in peru and the united states. participants were given either acyclovir or placebo for 12 to 18 months. the primary endpoint was hiv acquisition, and the study showed that suppression of hsv - 2 infection did not lead to a reduction in incidence of hiv. this is disappointing, the authors comment, given that infection with hsv - 2 is associated with significantly higher risk of hiv acquisition. they recommend further studies re - examine this assumption derived from observational studies and whether higher doses of acyclovir or other antiviral drugs would yield better results. the commentary is in response to two randomized controlled trials that tested the effect of sti treatment on hiv acquisition, both published in volume 371 of the lancet in 2008. the first was conducted in tanzania and the other was multicenter ( hiv prevention trials network 039 ). both found no effect of herpes simplex virus type 2 suppression on hiv acquisition, a surprising result based on observational data. the authors provide plausible reasons on why this may have been found. diagnosis and treatment of stis is a public health responsibility ; however, they conclude that hiv prevention strategies may need to be revised based on these new findings. resources should be directed to strategies that are proven efficacious. the commentary is in response to the view expressed by gray and wawer ( in " reassessing the hypothesis on sti control for hiv prevention, " lancet 2008 ) that hiv prevention strategies should be adjusted based on the results from two randomized controlled trials showing no effect of sti control on hiv acquisition. the authors disagree with this view and support sexually transmitted infection control in hiv prevention founded on the results of modeling studies. reducing funds to sexually transmitted infection diagnosis, treatment, and control could have adverse and unexpected effects on the hiv epidemic and should not be relaxed. this study used a mathematical model to examine whether


infection control in hiv prevention founded on the results of modeling studies. reducing funds to sexually transmitted infection diagnosis, treatment, and control could have adverse and unexpected effects on the hiv epidemic and should not be relaxed. this study used a mathematical model to examine whether or not interventions to treat sexually transmitted infections ( stis ) are cost - saving in populations with generalized hiv epidemics. the model was applied to the population characteristics of four cities in west africa and east africa, two with high hiv prevalence and two where prevalence was relatively low. it found that in settings where there is a generalized hiv epidemic, even though the proportion of hiv infections attributable to curable stis is likely to fall, interventions targeting these diseases are still highly cost - effective and potentially cost - saving, assuming stis have not been controlled by changes in risk behavior. this study compared the impact of three scenarios - - behavioral interventions with or without syndromic management of sexually transmitted infections and routine medical care - - on incidence of hiv in rural ugandan communities. awareness of herpes simplex virus type - 2 ( hsv - 2 ) symptoms improved in the behavioral intervention group and hsv - 2 incidence decreased in the group that also received syndromic sexually transmitted infection management. the study took reported condom use with the last casual partner as a proxy for high - risk sexual encounters and found that the behavioral interventions were associated with increased condom use. however, there was no measurable reduction in the incidence of hiv in any of the groups. this study looked at the impact of presumptive treatment of sexually transmitted infections on both hiv transmission and pregnancy outcome. the study randomized over 4, 000 pregnant women to either one presumptive treatment for sexually transmitted infections during pregnancy or vitamin and mineral supplements, with confidential notification and treatment referral for those diagnosed with syphilis during the study. the intervention resulted in less cervical and vaginal infections and fewer cases of infant ophthalmia, as well as significantly lower rates of low birth weight and neonatal mortality. however, there was no change in maternal hiv acquisition or in mother - to - child hiv transmission. this 2001 meta - analysis combined the best available evidence to date to examine the effect of sexually transmitted infections ( stis ) on hiv susceptibility. it found that many studies had been done in this area, but that a quantitative understanding of the interaction between the two was still lacking. although randomized controlled trials are the gold standard for proving causation, most studies on hiv and stis were observational.


many studies had been done in this area, but that a quantitative understanding of the interaction between the two was still lacking. although randomized controlled trials are the gold standard for proving causation, most studies on hiv and stis were observational. the authors recommend that future studies should strive to quantify the extent to which treating stis has an impact on hiv prevention. this study sought to test the hypothesis that controlling sexually transmitted infections ( stis ) at the population level would reduce the incidence of hiv, as had been found in the first clinical trial conducted in rural tanzania. the study was conducted in clusters of villages that encompassed social, and therefore sexual, networks in a rural district in southwestern uganda with high rates of both hiv and stis. the intervention group participants were given mass treatment with antibiotics while the control group participants were given vitamins and treatment for parasitic worms. although the prevalence and incidence of some stis significantly reduced in the intervention group versus the control group, there was no difference in hiv incidence. this was the first randomized controlled clinical trial to test the hypothesis that treating sexually transmitted infections ( stis ) would reduce hiv infection. the sti intervention program was conducted in 12 large communities and included setting up a reference clinic and laboratory, diagnosis and treatment training for existing staff, supplying drugs, and visits to villages served by each health facility to encourage people to seek prompt treatment for stis. the study found that in the intervention group, hiv incidence fell by more than two - fifths over two years, with the greatest impact among women aged 15 to 24 and men aged 25 to 34. subsequent clinical trials have not been able to replicate these results. this evaluation monitored the performance of avahan, the india aids initiative, using a supportive supervision tool to analyze outcomes from three perspectives : clinical, community, and management. the tool assessed the accessibility, acceptability, and contact coverage of sexually transmitted infection clinical services. it looked at barriers to access and monitored the quality of individual service components, including correct treatment, infection control, confidentiality, and counseling. monitoring demonstrated that avahan improved and sustained quality in terms of coverage, quality, technical support, community involvement, and networks of referrals. the monitoring tool provides timely and useful feedback but can be time - consuming and resource - intensive to implement. this study used biological and behavioral surveys to assess the impact of hiv prevention programs targeted at female sex workers, such as peer outreach and behavior change communication and provision of sexual health clinic services including syndromic and presumptive management of sexually transmitted


implement. this study used biological and behavioral surveys to assess the impact of hiv prevention programs targeted at female sex workers, such as peer outreach and behavior change communication and provision of sexual health clinic services including syndromic and presumptive management of sexually transmitted infections ( stis ). by follow - up, almost all participants had been visited by a peer educator, at least three - quarters had visited a drop - in center or sexual health clinic, and two - thirds had received presumptive treatment for chlamydia and gonorrhea. rates of condom use with clients improved but were static with regular partners. the prevalence of hiv reduced significantly across the board, but for curable stis, only street - based female sex workers had a reduced prevalence at follow - up. rates of curable stis did not decrease for brothel - and home - based female sex workers. twenty - seven antiretroviral therapy programs in africa, asia, and south america were surveyed to determine the extent of preventive services they offered. the survey showed that prevention efforts in most programs focused on health education to change behavior, supply of male condoms, and prevention of mother - to - child transmission. other interventions ( e. g., protocols for partner notification and interventions for high - risk groups such as serodiscordant couples and adolescents ) were less common. few sites offered regular sexually transmitted infection screening. survey respondents cited stigma, lack of financial resources, and high patient load as the main obstacles to implementing preventive services within antiretroviral therapy programs. this paper argues that the " fractured paradigm " of hiv prevention separate from programs to tackle sexually transmitted infections ( stis ) is counterproductive for both, given that weak control of stis may undermine hiv prevention efforts. the paper reviews the components, benefits, and feasibility of sti control and offers an alternative, unified paradigm to tackle hiv together with other stis. a useful table lays out the epidemiological parameters for integrating hiv prevention and sti control, detailing which target groups and diseases should get priority in which settings and when sti interventions are most effective in preventing hiv transmission. in haiti, voluntary hiv counseling and testing became a gateway to providing comprehensive sexual and reproductive health services including condom use promotion, family planning, maternal child health services, and services specifically for young people and survivors of sexual violence. integration made sense because most hiv infections in haiti are transmitted sexually, mother - to - child transmission is common, and people living with hiv face stigma and discrimination in accessing


child health services, and services specifically for young people and survivors of sexual violence. integration made sense because most hiv infections in haiti are transmitted sexually, mother - to - child transmission is common, and people living with hiv face stigma and discrimination in accessing health services. services evolved as needs were identified. although such integration requires great efforts to overcome the stigma associated with hiv, providing access to a range of health services greatly improves uptake of hiv counseling and testing. the randomized double - blinded and placebo - controlled trial enrolled kenyan female sex workers to test whether the use of antibiotic prophylaxis to treat common sexually transmitted infections ( stis ) would also reduce the rate of hiv acquisition. four hundred and sixty - six seronegative sex workers were enrolled in the study. all women were provided with risk - reduction counseling, condoms, treatment of symptomatic stis, and biannual screening and treatment for asymptomatic stis. oral azithromycin was given to half of the participants and the other half was given a placebo. there was no statistically significant difference between the treatment and placebo groups on hiv - 1 incidence. out of 35 seroconversion cases, 19 were in the treatment group and 16 were in the placebo group. there was a strong association between prior sti and incident hiv - 1 infection, and a significant positive effect of azithromycin on the reduction of incidence and prevalence of bacterial stis. a reduction in risky sexual behaviors in both groups was found. condom use with all clients increased from less to 20 percent to more than 50 percent within one month. the number of clients per week decreased from more than 16 to less than 6 within six months. there was a correlation between hiv - 1 infection and risky sexual behaviors within the year of seroconversion. the authors provide plausible reasons for the lack of effectiveness in reducing hiv - 1 acquisition with azithromycin treatment in this population. this study of kenya ' s syndromic management program for sexually transmitted infections ( stis ) used hiv sentinel surveillance data in patients with stis to identify changes in the proportion of patients with three syndromes associated with increased hiv acquisition : genital ulcer disease, urethral discharge, and vaginal discharge. incidence declined after the introduction of the program in 1995 and then increased again when free sti medication was no longer offered in 2001. as this was an ecological study, it was vulnerable to possible selection bias, and the authors recommend further studies such as


. incidence declined after the introduction of the program in 1995 and then increased again when free sti medication was no longer offered in 2001. as this was an ecological study, it was vulnerable to possible selection bias, and the authors recommend further studies such as randomized clinical trials to better understand the impact of complex interventions like sti syndromic management programs. this review of programs implementing syndromic management of sexually transmitted infections ( stis ) found that the processes for diagnosis and treatment of urethral discharge and genital ulcer disease in men were highly sensitive or had good cure rates, but those for women were less sensitive, particularly for those without symptoms. algorithms for vaginal discharge do not effectively detect gonorrhea or chlamydia in women. once the qualitative aspects of sti syndromic management are taken into account, the algorithms are likely to be even less sensitive than the literature suggests, and the authors urgently call for the development of affordable and effective rapid sti testing for use in resource - poor settings. the office of the global aids coordinator guidance is aimed at u. s. president ' s emergency plan for aids relief ( pepfar ) country teams to provide them with the latest scientific data on prevention programs to increase the impact of their country portfolios. prevention programs should be tailored to the epidemiological and social context of the country as well as optimizing on current programs implemented by other partners to help fill gaps. the guidance highlights the importance of knowing the country ' s epidemic, context, response, and costs, as well as ensuring that hiv prevention is part of the overall country continuum for the response. it also outlines current evidence and program activities that pepfar funds will support in relation to the diagnosis and treatment of sexually transmitted infections. national - and regional - level decision makers can use this programme guidance tool to set goals and priorities for interventions to address reproductive tract infections. the tool has 10 steps, 7 of which are for strategic situation analysis, followed by development of recommendations, implementation of new measures, and expansion of those found to be successful. it gives detailed guidance about what items should be covered at each stage. there is a section on how to conduct rapid assessment, including details on who should be interviewed and what interview tools can be used. there is also a suggested funding proposal outline for financing the first stage of the tool. this sexually transmitted infection ( sti ) management training program can be used for in - service training of health care workers in health centers, district hospitals, sti clinics, or


also a suggested funding proposal outline for financing the first stage of the tool. this sexually transmitted infection ( sti ) management training program can be used for in - service training of health care workers in health centers, district hospitals, sti clinics, or other first - level health facilities. seven modules cover sti prevention and control, syndromic case management, history - taking and examination, diagnosis and treatment, patient counseling and education, partner management, and recording and development. there is a trainer ' s guide and a cd - rom that can be used for self - learning or in conjunction with conventional training. the program is also available in french and spanish. these guidelines present sexually transmitted infections grouped by presenting symptom, with a section each for infections characterized by vaginal discharge, urethritis and cervicitis, and genital ulcers. each section gives the range of recommended treatment regimens. the guidelines also cover partner management and special issues such as sexually transmitted infections during pregnancy ; infections in babies, children, and adolescents ; and, where applicable, treatment of drug - resistant disease strains. these guidelines are based on laboratory diagnosis rather than the syndromic management method that is used in resource - constrained settings. these guidelines are part of a set of training materials that also includes a training manual, wall chart, and arabic language promotional materials. the guidelines cover the syndromic management of sexually transmitted infections and have a diagnostic flow chart and treatment table for each common syndrome. they also highlight the importance of education and counseling as a component of both treatment and prevention of sexually transmitted infections. the training manual provides a sample workshop agenda and slides for each session. the wall chart, with a summary of symptom and treatment information, is ideal for use in clinics. this guide is a reference manual for use in reproductive health care settings such as family planning and maternal and child health care clinics. it focuses on women, as they are the typical users of such clinics and are less likely to use sexually transmitted infection ( sti ) clinics. there are sections giving basic information on stis and other reproductive tract infections ( rtis ), improving prevention and treatment services, and the clinical management of rtis. hiv is mentioned in the guide but is not covered extensively because it is not a disease of the reproductive tract. periodic presumptive treatment for sexually transmitted infections : experience from the field and recommendations for research world health organization. ( 2008 ). this report describes experiences from the field in periodic and one - time presumptive treatment for sexually


of the reproductive tract. periodic presumptive treatment for sexually transmitted infections : experience from the field and recommendations for research world health organization. ( 2008 ). this report describes experiences from the field in periodic and one - time presumptive treatment for sexually transmitted infections ( stis ) among sex workers and their clients. the report followed on from a technical consultation on global experiences of presumptive sti treatment programs among high - risk populations. the consultation identified the conditions needed for effective sti control using presumptive treatment and produced recommendations for research. both topics are covered in this report, as is the effect of presumptive treatment on specific stis. the report presents case studies and offers brief guidance on operating such programs. view report ( pdf, 1. 96 mb ) the global strategy for the prevention and control of sexually transmitted infections 2006 - 2015 : breaking the chain of transmission world health organization. ( 2007 ). this document makes the case for a global strategy to tackle sexually transmitted infections ( stis ), describing the public health burden and the opportunities for an accelerated response such as the emergence of new and cost - effective technologies. the strategy aims to provide a framework for this response and is targeted at managers of national hiv prevention and sti control programs as well as other health sector stakeholders including health care providers, health ministers, and donors. it details both the technical strategy for sti prevention and control and an advocacy strategy for mobilizing resources and political and social leadership. view report ( pdf, 3. 1 mb ) guidelines for the management of sexually transmitted infections world health organization. ( 2003 ). these guidelines lay out the standardized treatment recommendations for syndromes associated with sexually transmitted infections ( stis ) using at - a - glance flowcharts and tables. there are also treatment recommendations for each specific sti. the guidelines detail the main considerations in choosing a treatment, such as cost, efficacy, treatment compliance, and availability. there is a chapter covering practical considerations in case management of stis and another on treatment of stis in children and adolescents. view report ( pdf, 2. 75 mb )


the mainstream media view of science seems to be : - - science is what scientists do. - what scientists do is science. doesn ’ t quite work does it? in too many cases, faith in science appears to be just that – faith. or maybe another case of credentialism? it may well be impossible to come up with a definition of science which always fits the real world, but credentialism has given us some dire science and shows every sign of delivering lots more. yet we still have useful principles available to stop the rot, such as positivism. i first came across positivism in my late teens, via a j ayer ’ s book language truth and logic. ayer ’ s uncompromising view on meaningful discourse seems extreme to me, but since then i ’ ve always been a positivist even though it appears to have drifted into a philosophical backwater. which is a pity, because positivism provides us with a good working yardstick of what is and isn ’ t science. falsifiability associated with popper has its advantages too, but in many cases we seem to end up with credentialism – verifying credentials rather than physical reality. it is insidious too, because my references to ayer and popper could be seen as credentialism. from wikipedia : - positivism is a philosophy of science based on the view that in the social as well as natural sciences, information derived from sensory experience, logical and mathematical treatments and reports of such data, are together the exclusive source of all authoritative knowledge. suppose we replace authoritative with scientific to avoid at least one minefield of fruitless wrangling. if so, then among other advantages, positivism accounts for the basic similarities between science and engineering. both are based on what works in a testable way in the real world. both accept the need for new ideas if physical reality blows away the old ones. the similarity is no coincidence. so why isn ’ t science as rigorously positivist as engineering? i think it is because science has expanded as both a business and as a tool of political advocacy. for an early example of science as a business we need look no further than sigmund freud and the so - called science of psychoanalysis leading to psychotherapy. whatever the merits or demerits of freudian psychoanalysis, it most certainly became a business which at best aligns itself only weakly with positivism. the id, ego and super - ego are not


of psychoanalysis leading to psychotherapy. whatever the merits or demerits of freudian psychoanalysis, it most certainly became a business which at best aligns itself only weakly with positivism. the id, ego and super - ego are not concepts amenable to physical verification. whether or not psychoanalysis was a model for other areas of science to expand beyond positivism i don ’ t know, but it may well have provided a paradigm of what is possible. there are many complexities to what we call science, much of down to our excessive reliance on credentialism plus a lack of rigour when it comes to insisting on physical verification. wouldn ’ t it be splendid if science journalists had a bash at verification before publication? however, many scientific enterprises successfully mix positivist science with business science. in other cases, the business pushes the positivist principles to one side. it varies from field to field and even within disciplines. physics for example. multiverse theories and string theories do not sit well with positivism, although they are not businesses either. unless of course one is cynical enough to count them as entertainment. for science as a political advocacy tool we have climate change, passive smoking and drugs policies. in these cases, positivism would introduce much needed rigor into the political exigencies. the unsurprising result is that these fields tend to attract scientists who pay more attention to credentials than physical reality. so it ’ s a complex picture, but easy enough to see how the sidelining of physical principles such as positivism has led to problems with certain sciences. unfortunately many people do not understand the rigor of positivism, nor its powerful methodological advantage. too many scientists are not rigorous positivists. are they still scientists?