International Response To Fight HIV/AIDS Among Children 'Tragically Insufficient' But 'Beginning To Change,' U.N. Report Says

The world's response to fighting HIV/AIDS among vulnerable children remains "tragically insufficient," but some countries are making progress in providing treatment for HIV-positive children and preventing transmission of the virus, according to a report released Tuesday by UNAIDS, UNICEF and the World Health Organization, the New York Times reports (Altman, New York Times, 1/17). The report, released on the first anniversary of the "Unite for Children, Unite Against AIDS" program, found 15.2 million children under age 18 have lost one or both parents to AIDS-related complications (AFP/Yahoo! News, 1/16). The campaign -- which is a partnership between UNICEF, UNAIDS, and other organizations and agencies -- aims to reduce the incidence of mother-to-child HIV transmission, curb the spread of the virus among young people, and provide protection as well as emotional and financial support to children who have lost parents to AIDS-related illnesses (Kaiser Daily HIV/AIDS Report, 11/10/05). The report says that 2.3 million children younger than age 15 were living with HIV in 2005 and that 10% of the 780,000 children in need of antiretroviral drugs had access to them during the same time period. About one-third of HIV-positive infants who do not have access to treatment die from AIDS-related complications in their first year, and half of them die from AIDS-related complications by age two, the report found. These statistics indicate that about 380,000 children died from AIDS-related illnesses last year, according to UNICEF. The report identifies seven countries -- Botswana, Cape Verde, the Dominican Republic, Jamaica, Namibia, Rwanda and Thailand -- that provided antiretrovirals to at least 20% of children in need of the drugs. The lack of access to prevention and treatment interventions has left about 15.2 million children orphaned, and the number is expected to increase to 20 million by 2010, according to the report. About 9% of HIV-positive pregnant women living in low- and middle-income countries in 2005 received antiretrovirals that could prevent MTC HIV transmission, up from 3% in 2003, the report found. About 10% of pregnant women living in sub-Saharan African capital cities are HIV-positive, according to the report. The majority of pregnant women in Africa do not have access to drugs aimed at preventing MTC HIV transmission, meaning that about one-third of their infants will become HIV-positive at or shortly after birth, according to UNICEF (New York Times, 1/17). The report also found that the most successful results occurred in countries that instituted a decentralized approach to HIV/AIDS service and training, demonstrated a political commitment to fighting the disease, and incorporated prevention and treatment to entire families (Leopold, Reuters, 1/16).

Recommendations
"Over the past year, there has been a broad, growing recognition of the need to intensify and accelerate action towards universal access to comprehensive prevention, treatment, care and support" for HIV/AIDS, the report says. It calls on governments to provide at least 10% of their HIV/AIDS funding for children and adolescents. According to the report, about $30 billion is required to address the prevention strategy set out by the Unite for Children campaign, which aims to provide services to 80% of HIV-positive mothers by 2010, provide antiretroviral or antibiotic treatment to 80% of children who need it, and reduce the number of HIV-positive young people by 25% within three years (AFP/Yahoo! News, 1/16).

The report is available online. Note: Adobe Acrobat is needed to view the report.

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

HIV/AIDS PSA Campaign 'Drawing Attention' Because Of Celebrities Involved, Messages, New York Times Reports

A "provocative" HIV/AIDS public service campaign airing on several media outlets is "drawing attention" nationwide because of the celebrities featured in the announcements and the "frank nature" of their messages, the New York Times reports. The campaign -- called "Look, listen, love, respect" -- has enlisted actresses Whoopi Goldberg, Amanda Peet, Rosie Perez and Susan Sarandon to deliver "candid, no-nonsense" messages linking drug use and risky sexual behavior with the spread of HIV among men who have sex with men, according to the Times. The Internet is a central focus of the campaign, which has launched a Web site, loveandrespect.us. Video clips of the commercials also can be viewed on YouTube and MySpace. The campaign is scheduled to air on two national cable television networks, Here! and Logo, as well as on local cable TV stations owned by companies such as Cablevision, Cox Communications and Time Warner. In addition, there are plans to air the announcements in clubs and bars in cities nationwide and to produce audio versions of the spots for the national Out Q channel of Sirius Satellite Radio, the Times reports. The campaign is a collaboration between the New York City-based organizations HIV Forum NYC and the Callen-Lorde Community Health Center. It is receiving financial backing from Broadway Cares/Equity Fights AIDS and Cable Positive, the Times reports. Dan Carlson, co-founder of HIV Forum NYC, developed the campaign with Jay Laudato, executive director of Callen-Lorde, and Colin Weil, a writer, director and producer. According to Carlson, the campaign features female actors because they "felt these honest, direct, loving messages would be heard best if told by women we can see as our mothers, best friends, sisters." He added, "They can tell us things we may not be ready to hear from each other" (Elliott, New York Times, 1/16).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

WHO's Plan To Monitor HIV Drug Resistance In Botswana Likely To Fail

A World Health Organization (WHO) plan to track transmitted resistance to HIV drugs in Botswana could fail because the threshold the organization has set is too high, according to new UCLA research.

The authors of the study, which will be published Jan. 17 in the peer-reviewed online journal PLoS ONE (), based their research on the WHO's Botswana antiretroviral program, which began in 2002 and now treats some 42,000 patients. The program's goal is to treat 85,000 patients by 2009, roughly 30 percent of all those infected in Botswana.

As greater numbers are treated, the likelihood that a small percentage of patients will develop strains of HIV that are resistant to antiretroviral drugs increases. These patients may then transmit the drug-resistant strains to others, but the rates at which this may happen are unclear. The WHO surveillance system is intended to detect transmitted resistance exceeding a 5 percent threshold by 2009, though officials with the organization have not determined at what point this threshold might be reached, if at all.

According to the UCLA study, the WHO's detection test is based on a sophisticated statistical method, but the 5 percent detection threshold is an arbitrary one. Study co-author Sally Blower, UCLA professor of psychiatry and biobehavioral sciences and a member of the UCLA AIDS Institute, said the WHO threshold was primarily based on guesswork.

"They did not make any mathematical predictions on how long it would take to get to their threshold," Blower said. "Essentially, they've guessed what would happen. They should have done things on a more quantitative basis."

Blower and co-author Raffaele Vardavas, a postdoctoral fellow in Blower's research group, developed a mathematical model that traces the random evolution of drug-resistant strains of HIV in Botswana through 2009. They found that drug resistance would indeed emerge but likely at a much slower rate than the WHO anticipates, and the organization would not be able to detect it.

Though easy to implement, the WHO's statistical test would detect transmitted resistance only after it has reached 5 percent, and that threshold would likely not be reached by 2009 unless the drug-resistant strains of the virus are extremely transmissible, the authors said.

The authors note that while the WHO's monitoring plan requires a small sample size and is relatively inexpensive, it may not be entirely cost-effective at the early stages of the treatment program due to the high threshhold. Instead, they suggest that checking for transmitted resistance early this year and dropping the threshold to about 3 percent would present a better picture of the situation in Botswana. Although a lower threshold requires a larger sample size and is therefore more expensive, it is much more likely to detect transmitted resistance and therefore would be more useful.

"If transmitted resistance is found to be at or above 3 percent, then repeating the WHO's test in the next scheduled occasion using a 5 percent threshold value would provide more information as to how quickly transmitted resistance is increasing in Botswana," Vardavas said. "Although this would be more expensive, it would probably be more cost-effective than the current strategy."

###

The National Institute of Allergy and Infectious Diseases funded the study.

About the UCLA AIDS Institute

Established in 1992, the UCLA AIDS Institute is a multidisciplinary think tank drawing on the skills of top-flight researchers in the worldwide fight against HIV and AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social science, public health, nursing, and disease prevention. Their findings have led to advances in treating HIV as well as other diseases, such as hepatitis B and C, influenza, and cancer.

Contact: Enrique Rivero
University of California - Los Angeles

Washington, D.C., Free Clinic To Close, Staff To Join Whitman-Walker Clinic

The Washington, D.C.-based Washington Free Clinic, which has provided low-cost or no-cost health care services since 1968 to people in the city, is scheduled to close on Friday, and its staff will be joining the Whitman-Walker Clinic, the largest provider of HIV/AIDS services in the region, the Washington Post reports. The Free Clinic serves about 1,800 patients, many of whom are working poor people and immigrants from Central America or Africa without health insurance. The clinic has a staff of about 50 volunteer doctors and nurses. Whitman-Walker -- which was launched by the Washington Free Clinic in 1973 as the Gay Men's VD Clinic and five years later became a separate organization -- is expanding its medical services in the district. Whitman-Walker has 7,000 clients, facilities in the district and Northern Virginia, and a $22 million budget. According to the Post, the alliance between the two clinics also will benefit Whitman-Walker after it experienced financial problems in 2005 that forced its leaders to "reconsider its long-term future," the Post reports. Gardiner Lapham, chair of the Free Clinic board, said, "It does come full circle. [Whitman-Walker is] now taking care of us," adding that closing is "really painful, but it's the right thing for the community." Free Clinic officials said they expect to be treating both Whitman-Walker and former Free Clinic clients by Jan. 29 (Levine, Washington Post, 1/14).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Boston Micromachines' New Deformable Mirror To Enhance Retinal Imaging Systems For Earlier Detection Of Leading Eye Diseases

Boston Micromachines Corporation (BMC), a leading provider of MEMS-based deformable mirror (DM) products for adaptive optics (AO) systems, today announced it has manufactured an enhanced DM capable of meeting the criteria for ultra-high resolution retinal imaging, which is necessary for early detection of ocular diseases. The new mirror will meet the demanding requirements of both OEM retinal imaging systems as well as vision science and microscopy researchers who use AO for biological imaging.

"This new deformable mirror represents a significant scientific advancement in the field of biological imaging, specifically vision science. Until now doctors were limited in their ability to gain a clear view of the human retina due to image distortion caused by tissue-induced wavefront aberration. Our deformable mirror corrects for that wavefront aberration," said Paul Bierden, president of Boston Micromachines. "This marked improvement in retinal imaging will provide doctors the technology necessary to detect the leading diseases of the eye: glaucoma, diabetic retinopathy, and age-related macular degeneration years earlier than previously possible. Earlier detection will result in earlier diagnosis and earlier treatment."

The new mirror, which is an enhanced version of Boston Micromachines' flagship product the Multi-DM, delivers increased stroke while maintaining the high resolution afforded by its 140 independently controlled actuators. The mirror's 3 kilohertz frequency capability allow for high speed real-time imaging with a 6mm aperture perfectly suited for a dilated pupil. In addition, the new Multi-DM also provides the wavefront amplitude correction needed for older eyes by offering 6 microns of stroke. This translates to 12 microns of wavefront correction, the most wavefront correction demonstrated by any MEMS DM on the market today. The development work on this MEMS device was partially funded by the Center for Adaptive Optics, a NSF Science and Technology Center, and by a National Eye Institute Phase I SBIR.

The improved Multi-DM will also enable enhancements in other biological imaging areas. Biological imaging instruments often suffer from resolution limitations, constraining the ability of researchers and clinicians to detect critical detail. This loss in resolution is due to the wavefront aberrations induced by the tissue media through which light passes to reach the object of interest, such as a cell, retina, or tumor. The Multi-DM's ability to actively correct for these aberrations will restore resolution and enable the extracting of vital information from biological specimens.

"The ever increasing strokes in deformable mirrors, such as the 6um achieved with BMC's new Multi-DM, will allow for deeper AO corrected imaging in biological specimens, more effective correction when used at longer wavelengths, and improved performance specifications in systems such as the Adaptive Scanning Optical Microscope (ASOM) and other AO based imaging systems," said Ben Potsaid, Research Scientist at the Center for Automation Technologies and Systems (CATS) located at Rensselaer Polytechnic Institute (RPI).

"Commercial systems require low cost DMs. Never before has there been a compact, affordable DM available with this magnitude of resolution. Ours is the only technology that meets the criteria of resolution, speed, size, stroke," said Bierden. "This will enable adaptive optics to become a reality for commercial instruments."

About the Multi-DM

The Multi-DM is the flagship product in Boston Micromachines' award- winning suite of MEMS deformable mirrors, which are used to improve resolution in microscopes, telescopes, and ophthalmic instruments. The popular and versatile Multi-DM offers sophisticated aberration compensation in an easy-to- use package. Typical applications include advanced retinal imaging systems, laser communication and beam forming.

At Photonics West

Boston Micromachines will be demonstrating the new Multi-DM at Photonics West 2007 (January 20-25) in San Jose, California, at Booth 6180.

Availability

The new Multi-DM is available immediately.

About Boston Micromachines Corporation

Founded in 1999, Boston Micromachines Corporation (BMC) is the leading provider of advanced MEMS-based mirror products for use in commercial AO systems, applying wavefront correction to produce high resolution images of the human retina and enhance images blurred by the Earth's atmosphere. The company's suite of award-winning compact DM products are the most economical high-performance mirrors in the market today. They are widely used in vision science applications such as advanced optic retinal imaging, long range laser communications and astronomy, including NASA's search for planets in other solar systems. Customers include leading manufacturers of optical imaging and communication systems, governmental agencies and contractors and vision science research laboratories worldwide, such as NASA, UCal Berkeley, Lockheed Martin and Boston University. Located in Watertown, Mass., BMC is privately held and also offers custom design-manufacturing services. For more information on BMC, please visit http://www.bostonmicromachines.com.

Boston Micromachines Corporation
http://www.bostonmicromachines.com

Health Department Offers Tips To Avoid Norovirus Infection

With outbreaks of viral gastroenteritis, or "stomach flu," continuing to be reported across the commonwealth and nation, the Pennsylvania Department of Health is reminding the general public about ways they can help to avoid norovirus infection -- a common cause of the illness.

"Norovirus infection is very common this time of year and it's very contagious," said state Health Secretary Dr. Calvin B. Johnson. "If you have symptoms of norovirus, such as vomiting and diarrhea, you should try to stay home and practice good hygiene, like washing your hands frequently and thoroughly to avoid spreading the illness to others."

Norovirus symptoms often begin suddenly and can include nausea, stomach cramping, vomiting and diarrhea. Norovirus illness can be a difficult experience for those affected, but it is normally short-lived and people recover within 12 to 60 hours.

The spread of norovirus can be prevented by following some simple guidelines:

-- Frequently wash your hands, especially after using the bathroom and changing diapers, and before eating or preparing food.

-- Anyone ill with diarrhea should not prepare food for other people. In particular, people with diarrhea should not work in restaurants, day care centers, or medical settings unless they are cleared to do so by their doctor or the local health department.

-- Carefully wash fruits and vegetables, and steam oysters before eating them.

-- Thoroughly clean and disinfect contaminated surfaces immediately after an episode of diarrhea or vomiting by using a bleach-based household cleaner.

-- Immediately remove and wash clothing or linens that may be contaminated with virus after an episode of diarrhea or vomiting (use hot water and soap).

-- Flush or discard any vomit and/or stool in the toilet and make sure that the surrounding area is kept clean.

Because norovirus is very contagious, sudden outbreaks can result when people bring the infection into facilities such as hospitals, residential and nursing homes and schools. No one who has suffered from vomiting and diarrhea should visit or work in crowded places until they have been completely free from symptoms for at least 48 hours.

For most healthy individuals, drinking plenty of fluids and resting at home is sufficient to recover from a norovirus infection and there is no need for hospital treatment. However, the elderly or very young can sometimes get more severe infection and they, or anyone else who is concerned about their medical condition, should talk to their doctor for advice.

For more information about norovirus, visit the Centers for Disease Control and Prevention Web site at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm.

Pennsylvania Department of Health
http://www.state.pa.us/

Study Uncovers A Lethal Secret Of 1918 Influenza Virus

In a study of non-human primates infected with the influenza virus that killed 50 million people in 1918, an international team of scientists has found a critical clue to how the virus killed so quickly and efficiently.

Writing this week (Jan. 18, 2007) in the journal Nature, a team led by University of Wisconsin-Madison virologist Yoshihiro Kawaoka reveals how the 1918 virus - modern history's most savage influenza strain - unleashes an immune response that destroys the lungs in a matter of days, leading to death.

The finding is important because it provides insight into how the virus that swept the world in the closing days of World War I was so efficiently deadly, claiming many of its victims people in the prime of life. The work suggests that it may be possible in future outbreaks of highly pathogenic flu to stem the tide of death through early intervention.

The study "proves the 1918 virus was indeed different from all of the other flu viruses we know of," says Kawaoka, a professor in the UW-Madison School of Veterinary Medicine and at the University of Tokyo.

The new study, conducted at the Public Health Agency of Canada's National Microbiology Laboratory in Winnipeg, Manitoba, utilized the 1918 flu virus, which has been reconstructed by researchers using genes obtained from the tissues of victims of the great pandemic in a reverse genetics process that enables scientists to make fully functioning viruses.

"In 1918, the existence of viruses had barely been recognized. In fact, the influenza virus wasn't identified until 1933. Thanks to recent technological advancements, we are now able to study this virus and how it wreaked havoc around the globe," explains Darwyn Kobasa, research scientist with the Public Health Agency of Canada and lead author of the new study. "This research provides an important piece in the puzzle of the 1918 virus, helping us to better understand influenza viruses and their potential to cause pandemics."

By infecting monkeys with the virus, the team was able to show that the 1918 virus prompted a deadly respiratory infection that echoed historical accounts of how the disease claimed its victims.

Importantly, the new work shows that infection with the virus prompted an immune response that seems to derail the body's typical reaction to viral infection and instead unleashes an attack by the immune system on the lungs. As immune cells attack the respiratory system, the lungs fill with fluid and victims, in essence, drown. The mechanisms that contribute to the lethality of the virus were uncovered by University of Washington researchers using functional genomics, a technique in which researchers analyze the gene functions and interactions. Learning more about the virulence mechanisms of the 1918 flu virus may help researchers understand how to keep the virus from causing such a severe immune response.

"This study in macaques, combined with our earlier research showing the host response in mice infected with the 1918 flu, suggests that the host immune response is out of control in animals infected with the virus," said Michael G. Katze, professor of microbiology at the University of Washington in Seattle, who led the functional genomics portion of the new study and led the previous mouse-based study. "Our analysis revealed potential mechanisms of virulence, which we hope will help us develop novel antiviral strategies to both outwit the virus and moderate the host immune response."

The same excessive immune reaction is characteristic of the deadly complications of H5N1 avian influenza, the strain of bird flu present in Asia and which has claimed nearly 150 human lives but has not yet shown a capacity to spread easily among people.

"What we see with the 1918 virus in infected monkeys is also what we see with H5N1 viruses," Kawaoka says, suggesting that the ability to modulate immune response may be a shared feature of the most virulent influenza viruses.

In the new study, conducted in a high-level biosafety laboratory (BSL 4) at the Public Health Agency of Canada's National Microbiology Laboratory, seven primates were infected with the reconstructed 1918 virus. Clinical signs of disease were apparent within 24 hours of infection and within eight days euthanization was necessary. The rapid course of the disease mirrors how quickly the disease ran its course in its human victims in 1918.

Upon infection, the virus grew rapidly in the infected animals, suggesting the agent somehow sets the stage for virulent infection: "Somehow, early in infection, this virus does something to the host that allows it to grow really well," says Kawaoka. "But we don't know what that is."

Knowing that the virus does something early in infection to trigger such a devastating immune response may provide biomedical researchers with clues about how to intervene and stop or mitigate the virus' potentially lethal effects, Kawaoka says.

"Things may be happening at an early time point (in infection), but we may be able to step in and stop that reaction."

###

In addition to Kawaoka, authors of the new Nature paper include Darwyn Kobasa, Steven M. Jones, Hideki Ebihara, Friederike Feldman, Judie B. Alimonti, Lisa Fernando, Yan Li and Heinz Feldman of Canada's National Microbiology Laboratory; Kyoko Shinya of Japan's Tottori University; John C. Kash and Michael G. Katze of the University of Washington; John Copps of the Canadian Food Inspection Agency's National Centre for Foreign Animal Disease; and Yasuko Hatta, Jin Hyun Kim, Peter Halfmann and Masato Hatta of UW-Madison.

The new study was supported by the Public Health Agency of Canada, the Japanese Ministries of Education, Culture, Sports, Science and Technology, and private grants to Kawaoka. - Terry Devitt.

Contact: Yoshihiro Kawaoka
University of Wisconsin-Madison

Built-in Molecular Brakes Curb The Sniffles

Researchers at Johns Hopkins have discovered how our anti-infection machinery turns itself down and limits the sniffles, congestion and fevers that are a side effect of the campaign against invading viruses. The discovery seems to solve part of the mystery of why the misery of the common cold lasts only so long.

The key to curbing any excess activity by the immune system apparently rests with Carabin, a newly discovered protein made by the specialized white blood cells that march in when a virus attacks.

Results of a study published online this week at Nature show that Carabin "acts like an internal brake to dial down the speed and intensity of an immune response so that it doesn't go too fast or too far, or careen out of control and attack healthy cells," says Jun O. Liu, Ph.D., professor of pharmacology, neuroscience and oncology at Hopkins.

Searching for proteins that control immunity, Liu and his team homed in on those that latch on to parts of cells that are active during an infection. "Carabin popped out," says Liu.

To see what Carabin could do, the research team added it to white blood cells already primed and ready for anti-infection action. The more Carabin in the cells, the less active the cells became.

When people are infected with a cold virus, for example, the virus enters cells and hijacks its works so that the cells become viral factories. The immune system's white blood cells go after these infected cells not only by fielding chemicals that kill them directly, but also by turning on genes that help out. When Liu and his group added Carabin to cells and then studied such genes, they discovered that Carabin disabled the "on" switches, keeping the genes off.

"By now we were pretty convinced that Carabin can turn down the immune system, so the next question was, 'what controls Carabin?'" Liu noted.

Tracking Carabin to its origins, the researchers said they were surprised to learn that viral infection not only turns on the immune system machinery, but also triggers the making of Carabin, which in turn shuts off the immune response.

"It's like having a built-in timer to keep the immune system in check," says Liu.

If Carabin turns out, after further study, to be a keystone natural inhibitor of immune responses, Liu added, it may prove useful in stopping such unwanted immune reactions as the rejection of transplanted organs.

###

The research was funded by the Department of Pharmacology at the Johns Hopkins School of Medicine and the Keck Foundation.

Authors on the paper are Fan Pan, Luo Sun, David Kardian, Katharine Whartenby, Drew Pardoll and Liu, all of Hopkins.

On the Web:

http://www.hopkinsmedicine.org/pharmacology/research/liu.html

http://www.hopkinsmedicine.org/pharmacology/index.html

http://www.nature.com/

Contact: Audrey Huang
Johns Hopkins Medical Institutions

Association Of Tuberculosis With Smoking And Indoor Air Pollution

All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere to read, download, redistribute, include in databases, and otherwise use subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.

Association of Tuberculosis with smoking and indoor air pollution

Smokers have an increased risk of tuberculosis (TB) infection, TB disease, and of dying from TB compared to people who do not smoke.

A new study from Hsien-Ho Lin and colleagues at Harvard School of Public Health reviewed the published evidence for an association between tobacco smoking, passive smoking, and indoor air pollution from fuels such as wood and charcoal and the risk of infection, disease, and death from TB. Among hundreds of reports from electronic databases, the authors reviewed 33 eligible papers on tobacco smoking and TB, five papers on passive smoking and TB, and five on indoor air pollution and TB.

The researchers separately assessed different aspects of TB risk: TB infection as measured by a positive tuberculin skin test, TB disease, and mortality from TB. They found an approximately 2-fold increase in risk of TB infection among smokers as compared with nonsmokers. The great majority of studies evaluating the link between active smoking and TB disease or TB mortality also showed an association, but these data could not be combined together because of wide potential differences between the studies. In addition, there was some association of TB with passive smoking, and also with indoor air pollution, though the evidence for these associations was more limited, and will need to be confirmed by further work.

The authors conclude that "TB control programs might benefit from a focus on interventions aimed at reducing tobacco and indoor air pollution exposures, especially among those at high risk for exposure to TB".

Citation: Lin H, Ezzati M, Murray M (2007) Tobacco smoke, indoor air pollution and tuberculosis: A systematic review and meta-analysis. PLoS Med 4(1): e20.

About the PUBLIC LIBRARY OF SCIENCE

PLoS is a nonprofit organization of scientists whose aim is to make the world's scientific and medical research literature a public resource. We are funded by a grant from the Gordon and Betty Moore Foundation to develop a publishing program based on the Open Access business model, whereby the costs of publication are paid upfront so that anyone with an internet connection can have access to the content, in a free and unrestricted manner. Our immediate goal is to launch two top-tier journals - PLoS Biology (in October, 2003) and PLoS Medicine (in 2004).

PUBLIC LIBRARY OF SCIENCE
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New Proteomic Method To Detect Inflammation In Amniotic Fluid

All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere to read, download, redistribute, include in databases, and otherwise use subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.

New proteomic method to detect inflammation in amniotic fluid

A score that measures the proteomic profile of amniotic fluid may predict inflammation before delivery. Researchers from Yale University, led by Catalin Buhimschi, have previously identified a set of four protein markers that were closely associated with inflammation in the amniotic fluid, and developed a score based on these proteins В­the "Mass Restricted" (MR) score. This score has been shown to be able to identify women at risk of preterm delivery. In the current study, the researchers assessed whether MR scores were associated with the outcome of pregnancy; the presence of infection in the placenta, and severe infection in the newborn baby.

169 women recruited into the study had a sample of amniotic fluid taken as part of their routine clinical management from which the protein MR score was calculated, and evidence of bacterial infection was sought. These results were then related to length of time until delivery, presence of placental inflammation after birth, and whether there was evidence of infection in the babies. In line with findings from their previous studies, women with a higher MR score gave birth sooner. There was also agreement between the MR score and evidence of inflammation in the placenta, and mothers with a high MR score were more likely to give birth to babies with suspected or confirmed sepsis.

In this group of women, the MR score seemed to be the most accurate in predicting inflammation when compared with other tests for inflammation such as white cell count, and may therefore provide a useful test for recognizing women at risk of preterm delivery and babies at risk of poor outcome. However, although promising, a further evaluation of the test in different populations will be needed before it could become a standard procedure in the clinic.

Citation: Buhimschi CS, Bhandari V, Hamar BD, Bahtiyar MO, Zhao G, et al. (2007) Proteomic profiling of the amniotic fluid to detect inflammation, infection, and neonatal sepsis. PLoS Med 4(1): e18.

About the PUBLIC LIBRARY OF SCIENCE

PLoS is a nonprofit organization of scientists whose aim is to make the world's scientific and medical research literature a public resource. We are funded by a grant from the Gordon and Betty Moore Foundation to develop a publishing program based on the Open Access business model, whereby the costs of publication are paid upfront so that anyone with an internet connection can have access to the content, in a free and unrestricted manner. Our immediate goal is to launch two top-tier journals - PLoS Biology (in October, 2003) and PLoS Medicine (in 2004).

PUBLIC LIBRARY OF SCIENCE
European Bioinformatics Institute
Wellcome Trust Genome Campus
CB10 1DS
http://www.plos.org