Provider barriers to the uptake of isoniazid preventive therapy among people living with HIV in Ethiopia.

SETTING: Sixty-seven government health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services across Ethiopia. OBJECTIVE: To examine clinician barriers to implementing isoniazid preventive therapy (IPT) among people living with HIV. DESIGN: A cross-sectional study to evaluate the provider-related factors associated with high IPT coverage at the facility level. RESULTS: On bivariate analysis, the odds of high IPT implementation were lower when clinicians felt patients were negatively affected by the side effects of IPT (OR 0.18, 95%CI 0.04-0.81) and perceived that IPT increased multidrug-resistant TB (MDR-TB) rates (OR 0.66, 95%CI 0.44-0.98). The presence of IPT guidelines on site (OR 2.93, 95%CI 1.10-7.77) and TB-HIV training (OR 3.08, 95%CI 1.11-8.53) had a positive relationship with high IPT uptake. In the multivariate model, clinician's perception that active TB was difficult to rule out had a negative association with a high IPT rate (OR 0.93; 95%CI 0.90-0.95). CONCLUSIONS: Clinician impression that ruling out active TB among HIV patients is difficult was found to be a significant barrier to IPT uptake. Continued advancement of IPT relies greatly on improving the ability of providers to determine IPT eligibility and more confidently care for patients on IPT. Improved clinician support and training as well as development of new TB diagnostic technologies could impact IPT utilization among providers.

Imaging divertor strike point splitting in RMP ELM suppression experiments in the DIII-D tokamak.

Fast visible imaging of the lower divertor from above is used to study the structure and dynamics of lobes induced by resonant magnetic perturbations (RMPs) in Edge-Localized Mode (ELM) suppression experiments in DIII-D. The best compromise between the amount of light and sharp imaging was obtained using emission at 601 nm from Fulcher band molecular deuterium. Multiple spatially resolved peaks in the D2 emission, taken as a proxy for the particle flux, are readily resolved during RMPs, in contrast to the heat flux measured by infrared cameras, which shows little spatial structure in ITER-like conditions. The 25 mm objective lens provides high spatial resolution (2-4 mm/pixel) from the centerpost to the outer shelf over 40° toroidally that overlaps the field of view of the IRTV that measures the divertor heat flux, allowing direct comparison in non-axisymmetric discharges. The image is coupled to a Phantom 7.3 camera using a Schott wound fiber bundle, providing high temporal resolution that allows the lobe dynamics to be resolved between ELMs and across ELM suppression onset. These measurements are used to study the heat and particle flux in 3D magnetic fields and to validate models for the plasma response to RMPs.

Factors promoting and inhibiting sustained impact of a mental health task-shifting program for HIV providers in Ethiopia.

BACKGROUND: Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia. METHODS: Convergent mixed-methods quasi-experimental study. Sustained impact was measured by trained/not-trained provider differences in case detection and management 16 months following the end of formal support. Factors related to sustainability were examined through interviews with trained providers. RESULTS: Extent of sustained impact: Trained providers demonstrated modest but better agreement with standardized screeners (greater sensitivity with similar specificity). They were more likely to request that patients with mental health problems return to see them v. making a referral. Factors promoting sustainability (reported in semi-structured interviews): provider belief that the treatments they had learned were effective. New interactions with on-site mental health staff were a source of ongoing learning and encouragement. Factors diminishing sustainability: providers feelings of isolation when mental health partners left for work elsewhere, failure to incorporate mental health indicators into administrative data, to re-stock staff education materials, and to build formal mechanisms for generalist-mental health staff interaction. CONCLUSIONS: An intervention seen as feasible and effective, and promotion of relationships across professional lines, helped generalists sustain new skills. Failure to address key system context issues made use of the skills unsustainable as external supports ended.

Authors' Response to Strasberg's "Comment on 'Measurement of the frequency dependence of the ultrasonic parametric threshold amplitude for a fluid-filled cavity' " [J. Acoust. Soc. Am. 125, 1857 (2009)].

This letter is a response to Strasberg's recent paper, "Comment on 'Measurement of the frequency dependence of the ultrasonic parametric threshold amplitude for a fluid-filled cavity.'" The authors dispute the conclusions of Strasberg regarding the effect observed by Teklu et al. [J. Acoust. Soc. Am. 120, 657-660 (2006)] published previously in JASA.