ObjectivesTo describe the risk factors for treatment delay and the effect of delay on the severity of tuberculosis (TB) in a prospectively followed TB cohort at the Bandim Health Project in Guinea-Bissau.BackgroundTreatment delay in patients with TB is associated with increased mortality and transmission of disease. However, it is not well described whether delay influences clinical severity at diagnosis. Previously reported risk factors for treatment delay vary in different geographical and cultural settings. Such information has never been investigated in our setting. Change in delay over time is rarely reported and our prospectively followed TB cohort gives an opportunity to present such data.ParticipantsPatients were included at the time of diagnosis at three local TB clinics and the national TB reference hospital. Inclusion criteria were age >15 years and diagnosis of TB by either sputum examination or by the WHO clinical criteria. Patients with extrapulmonary TB were excluded.Primary and secondary outcome measuresThe primary outcome was treatment delay. Delay was assessed by patient questionnaires. The secondary outcome was Bandim TBscore as a measure of TB morbidity and all-cause mortality.ResultsA total of 1424 persons were diagnosed with TB in the study area between 2003 and 2010. We included 973 patients with TB in the study. The median treatment delay was 12.1 weeks. Risk factors for delay were low educational level, HIV-1+HIV-2 dual infection and negative sputum smear. TB treatment delay decreased by 10.3% (7.9–12.6%) per year during the study period. Delay was significantly associated with clinical severity at presentation with 20.8% severe TB cases in the low delay quartile compared with 33.9% if delay was over the median of 12.1 weeks.ConclusionsLong treatment delay was associated with more severe clinical presentation. Treatment delay in TB cases is decreasing in Guinea-Bissau.

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SUMMARYOne of the main challenges in earthquake risk mitigation is the assessment of existing buildings not designed according to modern codes and the development of effective techniques to strengthen these structures. Particular attention should be given to RC frame structures with masonry infill panels, as demonstrated by their poor performance in recent earthquakes in Europe. Understanding the seismic behaviour of masonry-infilled RC frames presents one of the most difficult problems in structural engineering. Analytical tools to evaluate infill-frame interaction and the failure mechanisms need to be further studied. This research intends to develop a simplified macro-model that takes into account the out-of-plane behaviour of the infill panels and the corresponding in-plane and out-of-plane interaction when subjected to seismic loadings. Finally, a vulnerability assessment of an RC building will be performed in order to evaluate the influence of the out-of-plane consideration in the building response.

Recent earthquakes show that masonry infill walls should be taken into account during the design and assessment process of structures, since this type of nonstructural elements increase the in-plane stiffness of the structure and consequently the natural period. An overview of the past researches conducted on the modelling of masonry infilled frame issues has been done, with discussion of past analytical investigations and different modelling approaches that many authors have proposed, including micro-and macro-modelling strategies. After this, the present work presents an improved numerical model, based on the Rodrigues et al. (J Earthq Eng 14:390-416, 2010) approach, for simulating the masonry infill walls behaviour in the computer program OpenSees. The main results of the in-plane calibration analyses obtained with one experimental test are presented and discussed. For last, two reinforced concrete regular buildings were studied and subjected to several ground motions, with and without infills' walls.

BackgroundDecisions about when to start an antiretroviral therapy (ART) are normally based on CD4 cell counts and viral load (VL). However, these measurements require equipment beyond the capacity of most laboratories in low-income and middle-income settings. Thus, there is an urgent need to identify and test simple markers to guide the optimal time for starting and for monitoring the effect of ART in developing countries.Objectives(1) To evaluate anthropometric measurements and measurement of plasma-soluble form of the urokinase plasminogen activator receptor (suPAR) levels as potential risk factors for early mortality among HIV-infected patients; (2) to assess whether these markers could help identify patients to whom ART should be prioritised and (3) to determine if these markers may add information to CD4 cell count when VL is not available.DesignAn observational study.SettingThe largest ART centre in Bissau, Guinea-Bissau.Participants1083 ART-naïve HIV-infected patients.Outcome measuresAssociations between baseline anthropometric measurements, CD4 cell counts, plasma suPAR levels and survival were examined using Cox proportional hazards models.ResultsLow body mass index (BMI≤18.5 kg/m2), low mid-upper-arm-circumference (MUAC≤250 mm), low CD4 cell count (≤350 cells/μl) and high suPAR plasma levels (>5.3 ng/ml) were independent predictors of death. Furthermore, mortality among patients with low CD4 cell count, low MUAC or low BMI was concentrated in the highest suPAR quartile.ConclusionsIrrespective of ART initiation and baseline CD4 count, MUAC and suPAR plasma levels were independent predictors of early mortality in this urban cohort. These markers could be useful in identifying patients at the highest risk of short-term mortality and may aid triage for ART when CD4 cell count is not available or when there is shortness of antiretroviral drugs.