Erika Lyles joined the Hope and Healing Center & Institute in March of 2019 as a Faith Community Advisor. Prior to this position, she spent five years working in health promotion and advocacy with a focus on health disparities and mental health in historically minoritized populations. Erika holds a Masters of Public Health in Behavioral Science and Health Education degree from Emory University. In her spare time, she enjoys watching documentaries and ice skating.


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USA TODAY/Pew poll: Obama struggles with Millennials
Posted by QuestCinq on Sunday, December 15, 2013 · Leave a Comment
President Obama sees his approval rating fall to 45% among young voters.
WASHINGTON — Millennials have provided invaluable political support to President Obama over the course of his presidency, voting for him by a roughly 2-to-1 margin in his two successful campaigns against Mitt Romney and John McCain.
But as Obama tries to climb out of a 2-month-long malaise that saw his popularity sink with the fumbled rollout of the federal health care exchange, the president appears to have nearly as much work to do with young people as he does with older Americans.
Forty-five percent of 18- to 29-year-old Americans say they approve of the way Obama is handling his job; 46% disapprove of his job performance, according to a year-end USA TODAY/Pew Research Center Poll. The president's approval rating with young Americans — which stood at 67% just ahead of his second inauguration less than a year ago — now mirrors the general population, according to the poll.
The USA TODAY/Pew sample is of only 229 young Americans — a subset of 2,001 adults polled from Dec. 3-8 — and has a margin of error of +/- 8 percentage points.
But the findings mirror other recent polling that suggests Obama has seen his approval rating slide with young Americans.
–Forty-nine percent of adults age 18-34 disapprove of the job Obama is doing as president, and 45% approve, according to a Wall Street Journal/NBC News poll released last week.
–A Harvard Institute of Politics poll published earlier this month found that Obama's approval rating with 18- to 29-year-olds now stands at 41%, a dramatic 11-point drop from April. Fifty-four percent said they disapprove of the president's performance. That poll has a margin of error of +/- 2.1 percentage points.
–In a Quinnipiac University poll conducted from Dec. 3 to 9, 41% approve and 49% disapprove of his performance among the 18-to-29 age group.
In the USA TODAY/Pew poll, just 41% approve of his signature health care policy, while 54% disapprove. Overall, 40% of Americans approve and 55% disapprove of his health care policy, according to the poll.
The tough polling numbers with young Americans offer a snapshot of the road ahead for the Obama administration in repairing damage caused by the troubled rollout of Obamacare, which has even worn on some of the president's most ardent supporters.
The administration has dedicated much of the president's time and political capital toward making implementation of Obamacare a success after battling with early problems — the glitch-riddled online exchange and the outrage that ensued when millions of Americans on the individual insurance market received cancellation notices because their policies didn't meet minimum benefit requirements set by the law.
Key to making the Affordable Care Act a success is enrolling plenty of young, healthy people whose participation will offset some higher risk and older uninsured Americans who are expected to flock to the exchanges.
Kyle Olberding, 23, an Army veteran who now works at a candy shop, said that he admires Obama for ending the war in Iraq and winding down the war in Afghanistan and credits the president for pursuing a diplomatic solution with Iran over its nuclear program.
But Olberding, of Wichita, Kan., said he is unhappy with the president's efforts on the economy, reducing the federal budget deficit and implementing the health care law. Olberding, who said he works full time but doesn't make much money, said he remains uncertain about whether he can afford health insurance and resents being required to purchase it.
"At this current point in my life, I have other things that need to be paid for and the extra cost is just not something I can afford right now," said Olberding, who said he hasn't yet explored the website or looked into the level of subsidy he might qualify for.
It's not the first time Obama has seen his approval rating plunge with Millennials, notes John Della Volpe, polling director at the Harvard Institute of Politics. Obama saw his approval rating drop with young Americans ahead of the 2010 midterm elections — in which Democrats lost control of the House — and again late in 2011 largely as a result of a then-stagnant economy. Each time he rebounded.
If Obama is going to have success rebounding again, it's essential he do a better job communicating with young Americans about the law, Della Volpe said.
Even among young poll respondents who say they approve of how Obama is handling his job, there has been a drop-off in the intensity of their backing of the president. Twenty-two percent said that they approve strongly of Obama's performance in the latest poll compared with 41% who said they approved strongly when they were surveyed in January.
"He has good intentions but the execution and communication of the health care law came through sloppily," said one poll respondent, Katrina Meyer, 29, of Indianapolis. "It was a little bit wearing."
Jonathan Scheidegger, 27, of Bethany, Okla., said he was optimistic when Obama was elected that he would get the economy on track and put a greater focus on the middle class than he felt George W. Bush did. While Scheidegger said Obama has done a better job than Bush, he said that the current president has failed to meet his expectations.
"There's just not a middle class anymore," said Scheidegger, a senior technical support specialist for a large company, who said he and his wife struggle to make ends meet despite both having good jobs. "I'd like to see that my hard work pays off. I'd like to see some things from the president and Congress where it's not just the poor getting poorer and the rich getting richer."
Aamer Madhani and Jim Norman
Source:USATODAY
Filed under Latest News, Polls · Tagged with

redpajama_set_name: RedPajamaCommonCrawl


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You've seen the summit, let us help you find the path.
Building technology-based products that are designed to have a meaningful impact on human performance, wellness and health is hard, very hard!
The technology is still maturing, hardware and app-based business models are challenging, and trying to compel people to keep using a device or an app for more than a week or two still eludes many companies.
However, with these challenges comes the possibility of making a positive impact on peoples' lives. Never before has the been such an opportunity to improve human health, fitness, happiness and overall thriving. This is why we love this space so much.
Building impactful products in this space requires a broad set of expertise and experience spanning technology, human physiology, behavioral science and product/business strategy. We are a "collaborative" of experts who bring the right mix of experience and expertise to conceptualize, build and launch successful products that drive sustained engagement and have a real impact on human thriving.
Path Collaborative is a consulting and research firm helping companies conceptualize, build and launch impactful products designed to improve human performance, wellness and health.
"I can't recommend Path Collaborative highly enough. They are second to none in project planning and execution and, most importantly, their deliverables outshine those of any other partner we have worked with in the areas of strategy, market analysis and go to market planning. We prefer our partners to become an extension of our team and Path Collaborative definitely fits the bill."
- Tommi Pyykönen, COO at ŌURA
Finding and capitalizing on new opportunities today requires a wide range of expertise and experience. We are a diverse group comprised of technologists, business strategists, behavioral scientists, and researchers.
At the core is the "collaborative" - a group of veterans from industry that each bring important expertise and capabilities.
Dan Ledger (Founder)
Dan brings almost a decade of leading research and strategy consulting projects in this space. He has both technical and business backgrounds, and deep expertise in wearable technology.
Dr. Kevin Bickart
Kevin is a neuroscientist at Stanford with deep academic and industry experience. Kevin's focus is leveraging brain science and non-invasive technology to measure and motivate human thriving.
Dr. Steph Habif
Steph is a behavioral scientist and behavioral designer with decades of experience helping companies design for sustained engagement. Steph is also a senior strategist at the Design Lab at UC San Diego.
Ben is a seasoned product developer with extensive experience in the apparel and smart fabric world. Ben formerly lead product innovation research at apparel company, VF Corp. Ben is the founder of IoClothes.
Kevin Callahan
Kevin co-founded MapMyFitness and also ran innovation at Under Armour following MMF's acquisition. Kevin has deep expertise in digital product strategy related to fitness, health and wellness.
Dr. Jeff Philips
Jeff is a practicing physician at Partners Healthcare. He was worked extensively using and testing consumer-oriented wearable technology in clinical settings.
A typical project will include one or more members of the "collaborative" depending on the expertise that is needed. Project teams also include additional researchers, consultants, and others as needed.
We help our clients with a broad range of questions and challenges. Generally, our projects tend to fall into three areas:
Identifying whitespace opportunities
Defining novel products and services
What types of opportunities are emerging as a result of changing technologies, business models and user behaviors?
What other organizations are helping to drive these changes? Where should we be looking to partner?
How are these opportunities poised to evolve? Where should we be focused?
How can we leverage our own assets in the process to create stronger differentiation?
Who are we targeting and what are their needs?
What should we go build?What's the value proposition? How do we build something people will stick with?
What does our competition look like? How will we differentiate? How do we position ourselves to compete effectively?
With whom can / should we partner with and how will we work together?
What is the business model? What type of growth can we expect?
How should we segment our market? Which segments should we target and why? How do we reach these segments?
How do we tell a unique story around this product? How does this story change for our target segments?
Who could we work with to create a broader reach? How would such a partnership work?
What risks do we face and how do we mitigate them?
Our clients are companies both large and small that are striving to push the envelope and create more impactful products and services.
Wearable device OEMs
Connected health companies
Apparel companies
Component and material suppliers
Interested in learning more? We'd love to hear from you.
© 2020 Path Collaborative


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President Zuma announces new Ministerial appointments on 03 October 2012
President Jacob Zuma has the pleasure to announce two new Ministerial appointments in his Cabinet.
The changes are as follows:
Ms Naledi Pandor, the Minister of Science and Technology, has been appointed as Minister of Home Affairs.
Mr Derek Hanekom, the Deputy Minister of Science and Technology takes over as Minister of Science and Technology.
"I congratulate Ms Pandor and Mr Hanekom on their appointments. They have distinguished themselves in their current portfolios and I am confident that they will do exceptionally well in their new responsibilities as well. I wish them all the best," President Zuma said.
The Minister of Science and Technology will be sworn in at the Union Buildings tomorrow, 4 October 2012, at 15h00.
Issued by Mac Maharaj on 079 879 3203
Enquiries: Zanele Mngadi on 082 330 1148 or Bongani Majola on 082 339 199


Please note: a separate procedure exists for internal reviews of bus safety infringement notices.
An internal review is when Bus Safety Victoria or a delegate conducts a review of a decision made by the Safety Director or a Bus Safety Compliance Officer (BSCO).
The BSCO's decision may be suspended while the review is taking place.
A person directly affected by a BSCO's decision is an 'eligible person' and can apply for an internal review. For example, you would count as an 'eligible person' if you have been served with an improvement or prohibition notice.
An operator of a bus service whose interests are affected by the decision.
The operator of a bus service given the direction.
If you want to apply for an internal review, please submit the Application for Internal review – Stay of Review form and supporting guidance.
Outside business hours you must contact the Duty Officer on 1800 301 151.


► How does LFTR achieve a waste stream consisting of virtually nothing but fission products? A series of chemical processing steps referred to (by Alvin Weinberg) as a "chemical kidney".
► CIET ("Compact Integral Effects Test") is presented by Dr. Per Peterson of UCB to Kirk Sorensen. CIET uses Dowtherm to validate computer models for passive heat removal from molten salt (cooled) reactors, under both steady-state and transient conditions.
► Ben Heard was featured in Robert Stone's documentary "Pandora's Promise", as an environmentalist who'd been mislead about nuclear power. Today, Ben advocates nuclear energy as a means of lowering Austrlia's carbon footprint. While Ben does not specifically advocate MSR technology, his talk is certainly worth listening to, and is equally applicable to my home province of oil-sands Alberta. I sent Ben an audio recorder to stick on his collar, and he stuck a camera on a tripod. Great presentation now on YouTube, no trip-to-Australia required!
► Carbon taken from water can be used to synthesise liquid fuel, as demonstrated by the U.S. Navy. It is an expensive process, but potentially economically viable using Navy Small Modular Reactors. Applying (modular) Molten Salt Reactors to the same process will drive down costs low enough for commercial application. Can the U.S. Navy be used to push these technologies forward?
► Actinium-225 & Bismuth-213 are radioactive medical isotopes which may revolutionize the fight against metastatic cancer cells. Dr. Julian Rosenman reviews historic & modern approaches to fighting cancer with radiation, and looks to future opportunities opened up by the thorium fuel cycle.
► The entire TEAC7 experience is contained within this single video embed. I encourage you to look at the entire list of TEAC7 presentations.


The history of religious thought and the history of human thought are closely interrelated, so the study of Chinese psychology of religion should pay attention to the study of Chinese history. In this paper, we summarize the history of Han Chinese psychology of religion in three stages from the perspectives of the history of Chinese thought, the history of Chinese religion, and the history of Chinese psychology. In the accumulation stage during the Spring and Autumn and Warring States periods, debates about "human nature" were central to a psychology of religion. We hope that this will be helpful for the further study of Chinese psychology of religion.
We are deeply grateful to professor Jim Nelson, who proofread our paper very carefully and gave us many insightful suggestions. We wish also to thank editors Alvin Dueck, Lewis Rambo and Kathy McKay for their helpful suggestions and editing work.


Houseplants that clean the air in your home!
Spending more time indoors due to unpredictable weather? Us too! Most people know that plants and trees clean our air, but which houseplants are best to have in your home for this purpose?
Aloe Vera is brilliant for use on burns but the plant itself also removes formaldehyde from the air.
This is meant to be one of the best air purifying plants, it also removes formaldehyde and is a natural humidifier.
This is known for removing the chemical benzene, a known carcinogen found in cigarette smoke, from the air. It also removes chemicals such as detergents, pesticides etc. A must have if anyone in the home is asthmatic!
This plant is also great at removing benzene, a known cancer-causing chemical. It also absorbs carbon dioxide and gives off oxygen overnight, which is said to improve your sleep! Make sure to put it somewhere that gets lots of light.
These houseplants clean the air by emitting high oxygen content, and purifies indoor air by removing chemicals.
An excellent all rounder for cleaning the air and removing chemicals. It thrives with low light and low water.
Said to remove formaldehyde commonly off-gased from paints, solvents and other synthetic materials and VOCs (volatile organic compounds). Give it as much light as possible!
Very effective at removing benzene, trichloroethylene (found in solvets and cleaners), formaldehyde and ammonia. This plant loves lots of water and partial sun.
This plant is also known for removing benzene. It's also said to remove mould spores in the air, making it great for bathrooms, kitchens and laundry rooms. Easy to care for, it likes a lot of water and indirect light.
An excellent all rounder and helps remove formaldahyde, carbon monoxide and other toxins or impurities in the air. It likes lots of light and water, it would be perfect on a windowsill or patio.
They're our top 10 plants for cleaning the air in our homes, what are your favourites?
This entry was posted in Food flowers, Garden, Gardening tips, Leisure and tagged air, clean, garden, GIY, home, houseplants, plants. Bookmark the permalink.


One of the attractions at OzCon earlier this month was a showing of James Ortiz's The Woodsman, produced in New York in 2015. It was a striking piece of theater stylishly adapted from L. Frank Baum's story of the Tin Woodman.
Another attraction was a preview of R. F. Wohl's performance as Baum. He was workshopping a new one-person show with an audience of knowledgable Oz fans. Afterwards I heard an attendee note that Baum consistently referred to his tin creation as a "Woodman," not a "Woodsman"—though many people (not just James Ortiz's play) now use the longer word.
That prompted some musing that perhaps one form had become more popular than the other, so I turned to the Google Books Ngram Viewer. I asked it to graph out the popularity of "woodman," "woodsman," and "woodchopper" from 1800 to 2000. I restricted the query to lowercase only, eliminating "Woodman" as a proper name (and almost all mentions of the Tin Woodman as well).
As you can see, "woodman" was the more popular word when Baum grew up and when he published The Wonderful Wizard of Oz in 1900. "Woodsman" rose suddenly in popularity starting in 1880 and around 1910 surpassed the shorter form. Both forms have been declining in print use since 1940 as we've moved away from a wood-based economy.
You don't seem to address the difference in the two professions, Woodman vs. Woodsman, though I'm not sure how well you could specify that in the search. But the word usage rates are clearly dependent on such, IMHO.
A woodman chopped and/or delivered firewood (like the Iceman or Milkman or Postman. A "Woodsman" is a forest ranger, naturalist, etc., that specializes in knowing about "the woods" and the failure to realize this difference in professions is what galls some of us - not the slight change to the spelling. Nick Chopper is a lumberjack not a forest ranger.


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Q: Two amazon lambda functions for one lex bot Can we use Two amazon lambda functions for one lex bot if one lambda function in python and other in node.js?

A: Yes we can have different Lambda functions for each intent in any language of your choice. So if you are using 10 intents in one Lex bot then you can have 10 different Lambda functions for each of your intent.
However if you are asking for two lambda functions for single intent then it is not possible, but still you can call as many lambda functions from your defined Lambda function.
Below is the code (python) to invoke another lambda function:
import boto3
import json

lambda_client = boto3.client('lambda')
a=[1,2,3]
x = {"list" : a}
invoke_response = lambda_client.invoke(FunctionName="name_of_other_lambda",
                                       InvocationType='RequestResponse',
                                       Payload=json.dumps(x))
print (invoke_response['Payload'].read())

Hope it help.

A: you can have two lambda functions for two different intents. You cannot have two lambda functions for the same intent

redpajama_set_name: RedPajamaStackExchange


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Random Thoughts On The Regis Exhibition Basketball Game
by Mark Overman | Nov 5, 2017
Hayden Dalton vs Regis University. Photo Credit: Pete Arnold
Editors note: We are in the midst of football season but the Wyoming Cowboys men's basketball team tipped off their season last Friday with a 75-65 exhibition win over Regis University. We are happy to introduce to you Mark Overman a new writer on WyoNation who will be writing about Wyoming Basketball this season.
James (ankle)/Adams (academics)/Mack (concussion) were all inactive for the exhibition game. Edwards said after the game that James and Adams should be available for the opening game against Chattanooga Nov. 10. I'm unclear and a little concerned about the status of Mack (unlike everyone else even Hunter Thompson, Mack wasn't sitting on the bench with the team). He was also a non-participant for the practice in Casper about a month ago because of a concussion. Hopefully, they're just being cautious and bringing him along slowly, because I believe he could definitely help the team this year.
Starting Line-up Thoughts
The starting lineup was Redding/Gorski/Maldonado/Dalton/Herndon. It wouldn't surprise me if this is the same starting lineup we see to begin the year with James replacing Maldonado. I was pleasantly surprised to see Maldonado so far up in the rotation to start the year. I'm sure a lot of this was due to James, Adams, and to a lesser extent Mack all being out. Maybe I'm just surprised because I'm still used to Shyatt and his aversion to playing Freshman.
Point Guard Rotation
I was happy to see Redding already ahead of Kelley in the rotation. Redding is clearly the more talented player. If I had to guess I would say that with Redding on the court and running the point we outscored Regis by at least 20pts. Adversely I would say with Kelley running the point Regis outscored the Cowboys by about 10pts.
Redding really impressed me. I think he will be a HUGE improvement from Lieberman and Kelley. Not only on offense but on defense as well. He seems to be a tenacious defender with legit D1 athleticism. Against Regis he finished with 14pts (10-10 from the line)/5asst/2to (1 was clearly not his fault).
While Redding flourished, Kelley floundered. Kelley had a few assist but had about 5 or 6 turnovers. He was clearly trying to force things instead of letting the game come to him. Maybe he realizes he is waaaay behind Redding and trying to play over his head. Kelley had a rough night and I believe him to be a limited player but in the past every time I've counted him out he has rebounded with solid performances. So I won't give up hope for him yet, but right now I see him on the outside looking in as far as the rotation.
Maldonado shined in his Cowboy debut. He scored 12pts with a combination of slashing/floaters/3pt shooting/ but that wasn't what was most impressive about his game. The most impressive thing was his overall demeanor, and that the game just didn't seem too big for him mentally or athletically. I thought he also played excellent defense.
I know it was just against a D2 team but it looks like our defense might be vastly improved from last season. A big part of that was the additions of Redding and Maldonado to the starting lineup. Regis didn't get many quality looks the entire first half. The defense wasn't quite as good in the second half but that was with more backups in the game.
Budda Jones is more athletic and a better ball handler than I initially thought. He didn't have a particularly good game. He was 0-4 from the field and he had a few silly turnovers. But I can definitely see the combination of size/skill/athleticism that made him a 4star recruit. I also found it interesting that during warm-ups he was in the group of wings and not bigs. This may have just been to the absence of James/Adams/Mack though.
Gorski Break Through?
Hopefully, this is the Gorski we see all year. He scored 20pts and was 4-7 from the 3pt line. But more realistically he will be the same streaky shooter he has been the previous three years. Although it wouldn't shock me if he was more consistent this year. He seems to be in the best shape of his UW career and as a Senior he should be more comfortable playing at this level. If somehow he could have a season like McManamen had two years ago, this team could be scary! But if he proves to be the streaky shooter he has always been then Edwards need to base his minutes accordingly. Some nights that would lead to 30 plus minutes and other nights it would mean closer to 15 minutes.
Turnovers still appear to be a major concern for this team. As fast as Edwards wants to play Wyoming will always have a high number of turnovers. But having 23 turnovers to only 14 assists against a D2 school just isn't going to cut it. Unfortunately, a lot of our turnovers come from guys who shouldn't be turning the ball over at a high rate. Ball handlers (Kelley) or upperclassman (Dalton/Gorski). It's only one game, and an exhibition game at that without our best player (James) and lineups were not likely to see in the regular season, so I'll give them a pass for now.
Moemeka On The Rise?
Moemeka has clearly passed Naughton on the depth chart. Naughton just doesn't fit the style of play Edwards prefers, which is unfortunate because I thought he had the potential to be a dominating center in the Mountain West. While Moemeka is a Derek Cooke Jr. type player with more basketball instinct. He always seems to get his hand on the ball for rebounds/blocks/steals/putbacks. He had three putbacks against Regis (only two counted, one was wrongly called over the back).
On one of the putbacks, he displayed both his ridiculous athleticism and his basketball IQ. As he went up for a putback the ball took an extra bounce and hung on the rim, he just hovered in the air and waited for the ball to be clear of the rim (avoiding goaltending) and then tipped the ball in. Juxtaposed to a guy like Barnes who was like a bull in a china shop with little basketball experience who would have most likely committed the offensive goaltending. I'm still convinced Moemeka can become an all-league defensive player but he does need to learn how to stay out of foul trouble.
Playing Time Distribution
As of right now, I would like to see the rotation as follows. Redding/Gorski/James/Dalton/Herdon as the starters with Adams as the sixth man. Then Maldonado/Moemeka/Mack/Jones rotating in and playing significant minutes. Naughton/Kelley/Mueller only playing sparingly with the potential to earn more minutes. Averbuck only in major garbage time.


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package org.apache.ignite.ml.knn.ann;

import java.util.TreeMap;

/**
 * The special class for fuzzy labels presenting the probability distribution
 * over the class labels.
 */
public class ProbableLabel {
    /** Key is label, value is probability to be this class */
    TreeMap<Double, Double> clsLbls;

    /**
     * The key is class label,
     * the value is the probability to be an item of this class.
     *
     * @param clsLbls Class labels.
     */
    public ProbableLabel(TreeMap<Double, Double> clsLbls) {
        this.clsLbls = clsLbls;
    }
}

redpajama_set_name: RedPajamaGithub


text:
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ARTICLE IN PRESS
10.25259/JPATS_29_2021
Incidence and predictors of death among adult patients treated for tuberculosis in two regions of Cameroon: 2010 to 2015
Adamou Dodo Balkissou1, Eric Walter Pefura-Yone2, Virginie Poka3, Alain Kuaban2, Djibril Mohammadou Mubarak2, Armel Djao Kora4, Fadil Donkou Raouph2, Josiane Touoyem Lonla5, Linda Mangoh Taguedjio6, Christopher Kuaban2
1Department of Medicine, University of Ngaoundere, Garoua, Cameroon
2Department of Internal Medicine and Specialties, University of Yaounde I, Yaoundé, Cameroon
3Department of Pneumology, Jamot Yaounde Hospital, Yaounde, Cameroon
4Department of Medicine, Higher Institute of Medical Technology, Baptist Hospital of Maroua, Maroua, Cameroon
5Department of Medicine, Higher Institute of Medical Technology, Centre des Urgences de Yaounde, Cameroon
6Department of Medicine, Higher Institute of Medical Technology, Polymer Polyclinic, Yaounde, Cameroon
*Corresponding author: Adamou Dodo Balkissou, Department of Medicine, Faculty of Medicine and Biomedical Sciences of Garoua, University of Ngaoundere, Garoua, Cameroon. dodobalkissou@gmail.com
Received: 2021-08-07 , Accepted: 2021-10-29 , Epub ahead of print: 2022-01-10 ,
© 2022 Published by Scientific Scholar on behalf of Journal of the Pan African Thoracic Society
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Balkissou AD, Pefura-Yone EW, Poka V, Kuaban A, Mubarak DM, Kora AD, et al. Incidence and predictors of death among adult patients treated for tuberculosis in two regions of Cameroon: 2010 to 2015. J Pan Afr Thorac Soc, doi: 10.25259/JPATS_29_2021
Mortality during tuberculosis (TB) remains high in Africa. The purpose of our study was to determine the incidence and predictors of death during TB treatment in Cameroon.
Materials and Methods:
Data of subjects aged ≥15 years were retrospectively extracted from registers in all TB diagnostic and treatment centers in the Western and Northern regions of Cameroon from 2010 to 2015. Cox regression models were used to determine predictors of death during TB treatment.
Of the 19,681 patients included, 12,541 (63.7%) were male and their median age (25th-75th percentile) was 34 (26–45) years. The cumulative incidence (95% confidence interval [CI]) of death during TB treatment was 8.0% (7.5–8.5%). The predictors (hazard ratios [95% CI]) of death were: Age >34 years (1.479 [1.295–1.688], P < 0.001), female sex (1.471 [1.286–1.683], P < 0.001), extra-pulmonary TB (1.723 [1.466–2.026], P < 0.001), human immunodeficiency virus infection (3.739 [3.269–4.276], P < 001]), TB treatment in the Western region (2.241 [1.815–2.768], P < 0.001), treatment before 2012 (1.215 [1.073–1.376], P = 0.002)and low body weight (1st quartile and 2nd quartile) (2.568 [2.133–3.092], [P < 0.001]) and (1.569 [1.298–1.896], P < 0.001) respectively.
The incidence of death during TB was relatively high in the Western and Northern regions of Cameroon. Recognition of these persons at greatest risk may improve care and reduce death durinng TB treatment.
Tuberculosis (TB) is one of the top ten causes of mortality in the world according to the World Health Organization (WHO).[1] In 2019, an estimated 10.0 million (range, 8.9 – 11.0 million) people contracted TB and 1.2 million (range, 1.1 – 1.3 million) also died from it, and an additional 208,000 (range, 177,000–242,000) with the human immunodeficiency virus (HIV).[2] The actual WHO strategic plan for TB is to reduce the number of deaths by 95% and the incidence of TB by 90% from 2015 to 2035.[3] In Cameroon, 24,740 cases of TB were reported in 2019, 27% of whom were people living with HIV, with 95% of them on antiretroviral therapy and the incidence rate of HIV/TB coinfection was estimated at 48 (31–69) per 100,000 people in 2019.[4] In the same year, the number of deaths due to TB was estimated at 7400 (4400–11,000) in HIV-negative subjects and 5000 (3200–7,200) in people living with HIV. An Ethiopian meta-analysis of 34 studies conducted from 2003 to 2016 found 8% of deaths during TB treatment.[5] In some African countries, the mortality rate during TB was high, reaching 10% in Ghana, 16% in Nigeria, and 20% in Southwest Ethiopia.[6-8] Predictors of death were TB/HIV coinfection, severe immunodeficiency, smear-negative pulmonary TB, low weight, and malnutrition.[9-11] Since 2008, many actions have been taken by the national TB program and stakeholders in many African countries, to improve decentralization of TB treatment and community TB treatment care, to reduce lost to follow-up and death due to TB.[12] Previous studies on TB mortality in Cameroon found HIV as the main risk factor for death during TB.[10,13,14] From 1996 to 2011 in the West Region of Cameroon, 8.6% of patients died during TB treatment and 36.5% of deaths occurred during the first 2 months of TB treatment. HIV infection, extra-pulmonary TB, sputum smear-negative pulmonary TB, and male sex were significant independent risk factors of death.[10] The prevalence of HIV infection was 35% on 1419 adult patients treated for TB in 2009 and the mortality rate was 10.5% in HIV positive patients. In the same year, death rate was 3.7% among those with CD4 above 200/mm(3) and 13% among those with CD4 below 200/ mm(3).[13] The prevalence of HIV in Cameroon declined from 5.1% in 2010 to 4.7% in 2015.[15] Similarly, HIV testing among patients with TB increased from 76% in 2010 to 93% in 2015,[15] and approximately 90% of HIV positive patients were on antiretroviral therapy. Knowing however that the incidence of TB/HIV coinfection had reduced in the last decades both worldwide and in Cameroon,[4] and the number of HIV patients on antiretroviral therapy had increased, we wanted to provide an update on the risk factors of death during TB. We therefore carried out this study with the aim to determine the incidence and predictors of death during TB treatment in two regions of Cameroon.
Design and study population
The study population consisted of a retrospective cohort of all consecutive TB patients aged ≥ 15 years who were put on anti-TB treatment between January 2010 and December 2015 in all the TB diagnostic and treatment centers (DTC) of the West and North Regions of Cameroon. Each subject was retrospectively followed over an 8-month period for new cases and 10 months for retreatment cases. We excluded patients with missing data on age, sex, and outcome.
Study setting
Cameroon is a Central African country with an estimated population of 24,910,305 inhabitants in 2020.[16] During the study period, there were 20 operational DTC in the Western region and 17 operational DTC in the Northern Region. The study was conducted in all the TB DTC of the two regions. According to the health pyramid, each region had only one DTC at the regional hospital (third category) and other DTCs were located in the district hospital (fourth category). In these DTC and in accordance with international guidelines and National Tuberculosis Control Program guidelines of Cameroon,[17] pulmonary TB and extra-pulmonary TB was diagnosed after clinical examination including anthropometric measurements (weight and height), microscopy (sputum smear), and other paraclinical exams. TB management was the same in all DTCs in Cameroon during the study period.[17] The drugs were available and dispensed free of charge in DTC. Antiretroviral drugs recommended for all patients with HIV were available and given free of charge in all DTC of Cameroon.
Each patient with TB was classified and treated according to bacteriological status (smear positive or negative pulmonary TB), disease location (pulmonary or extrapulmonary TB), and therapeutic history (new case or retreatment [relapses, failures, and lost to follow-up]). The new cases were defined as patients who had never been previously treated with anti-TB drugs (or treated for <1 month).[17] Relapses were patients who currently had smear positive pulmonary TB, but who had previously been treated for active TB (bacteriologically confirmed or not) and who had been declared "cured" or "treatment completed" after complete TB chemotherapy. Failures were represented by patients undergoing treatment who had a positive microscopy during sputum smear control of the 5th month or later during treatment. The defaulters were defined as those who took TB treatment for a month or more and who, having discontinued this treatment for at least 2 months, present with symptoms of pulmonary TB and positive sputum tests. Those who have a negative sputum test when they return must complete the duration of the treatment initially prescribed to them.
Therapeutic regimens always consisted of two phases: An intensive initial phase and a continuation phase. During the intensive phase that lasted 2 months for new cases and 3 months for retreatment cases, the drugs used were: Rifampicin, Isoniazid, Ethambutol, Pyrazinamide, and Streptomycin which was associated for retreatment cases. During the continuation phase that lasted 4 months for new cases, 5 months for retreatment cases, and 10 months for certain particular forms (meningitis, Pott's disease); the drugs used were: Rifampicin, Isoniazid, to which Ethambutol was added in case of retreatment. Treatment could be taken entirely as an outpatient or hospitalized during the intensive phase for patients with altered general states. Treatment should be taken on a daily and regular basis until its completion.[17] Antiretroviral therapy was recommended for any HIV-positive patient with active TB regardless of the level of lymphocytes cluster differentiation (CD) type 4. Bacteriological controls were carried out periodically (end of 2nd month, 5th month, 6th month, or 8th month) to monitor the patient's progress during smear positive pulmonary TB treatment. The treatment outcomes of patients were recorded as: Cured, completed treatment, failure, death, lost to follow-up, and transfer. Those patients, whose sputum smear was negative during the last month of treatment and on at least one previous occasion, were defined as "cured." Treatment completed was defined for patients who finished treatment but did not meet the criteria for being classified as "cured" or "failed." "Failures" were patients whose smears of sputum were positive at the 5th month or later during well-conducted treatment. "Death" was defined as any patient who died for any reason during the course of the treatment for TB. Patients "lost to follow-up" were those whose treatment was interrupted for 2 consecutive months or more during the treatment period.
Data were extracted from TB treatment registers and treatment forms and registered in an electronic questionnaire previously developed in Epidata version 3.1 (Lauritzen, Denmark). At baseline, data were collected on the different variables that are useful for the study and then the outcomes. The patient's socio-demographic data were: Age, gender, place of residence, and place of treatment. The clinical baseline data were: Weight in Kilograms (Kg), type of TB (new cases or cases of relapse, failure, and lost to follow-up), form of TB (smear positive or negative pulmonary TB and extra-pulmonary TB), and the specific location of TB for extra-pulmonary TB. The biological data were sputum test results at the beginning of treatment, HIV status, and CD4 lymphocytes count. The treatment outcomes of patients were recorded as: Cured, completed treatment, failure, death, lost to follow-up, and transfer.
Patient and public involvement statement
This retrospective cohort did not involve patients in the development of the research question, in the design, in the recruitment, and conduct of the study. Thus, the results could not be disseminated to the study participants.
Ethical clearance for the study was obtained from the Institutional Review Board of the Faculty of Medicine and Biomedical Sciences of the University of Yaounde I, ID approval N° 0255/UY1/FMSB/VDRC/CSD and from the Faculty of Medicine and Pharmaceutical Sciences of the University of Douala, ID approval N°CEIUD/192/02/2015/T, N°CEI-Udo/1075/07/2017/T and N°1473/CEI-UDo/04/2018/T.
Administrative authorization to carry out the study at the TB DTC was granted by the authorities of the regional delegation of public health with the following ID approval number N°89/L/MINSANTE/ST/PNLT/GTC/DRSP/URTL_ CE, N°0386/NS/D/DRSPN/GRA, N°125/L/MINSANTE/SG/ DRSPO/CBF and N°126/L/MINSANTE/SG/DRSPO/CBF.
Data analysis was done using the Statistical Package for the Social Science (SPSS) version 23 software for Windows (IBMSPSS Inc., Chicago, US). The variables were summarized using frequencies. The Chi-squared test or where appropriate the exact Fisher test was used to compare proportions while the Student t-test or its non-parametric equivalent test was used for comparison of quantitative variables. For the analyses, follow-up time was time from treatment start to date of outcome which was presented into person-months (pm) at risk. The incidence density was calculated as follows.
Incidence density=Number of those deadTotal person - months of treatement
Kaplan–Meier analysis and log rank test (Mantel-Cox) were used to compare survival curves stratified by gender, previous TB treatment, type of TB, and HIV status. Deaths were compared to the rest of the study population (survivors = cured + completed + failed + defaulters + transferred). To estimate hazard ratios (HR) with corresponding 95% confidence intervals (CI), Cox proportional hazards modeling was done and used to determine risk factors for death. Covariates that were associated with each outcome measure with P < 0.10 were included in the multivariable analysis. Difference was considered to be significant if P < 0.05.
General characteristics of the study population
A total of 19,958 patient's records were reviewed, and 277 (1.4%) incomplete records were excluded. Of the 19,681 patient's records included in the study, 12,541 (63.7%) were male and 7140 (36.3%) were female subjects. The median age (25th–50th percentile) was 34 (26–45) years ranging from 15 to 120 years [Table 1]. Retreatment was observed in only 4.6% cases. Pulmonary TB was noted in 88.5% cases with smear negative pulmonary TB found in 10.6% of our study population. Pleural TB was the most frequent extra pulmonary localization as seen in 28.1% of cases, followed by lymph node TB and Pott's disease in 20.3% and 11.1% of cases, respectively. HIV serology was positive in 5,167/17,691 (29.2%) patients who did the test.
Table 1:: General characteristics of the study population.
n=19,681 (%)
≤34 9882 (50.2)
>34 9799 (49.8)
Minimum-Maximum 15–120
Female 7140 (36.3)
Male 12,541 (63.7)
Region of registration
West 7,928 (40.3)
North 11,753 (59.7)
Year of registration
≤2012 9,900 (50.3)
>2012 9,781 (49.7)
Type of patients
Retreatment 895/19,499 (4.6)
New cases 18,604/19,499 (95.4)
Referred patients
Yes 429/19,671 (2.2)
No 19,242/19,671 (97.8)
Median (IQR) 56 (14)
<25th percentile 2067/8227 (25.1)
25th –50th percentile 1957/8227 (23.8)
>75th percentile 2033/8227 (24.7)
Form of tuberculosis
EPTB 2261 (11.5)
PTB 17,420 (88.5)
SNPTB 1845/17,416 (10.6)
SPPTB 15,571/17,416 (89.4)
Initial microscopy
≥2 + 8666/15,528 (55.8)
<2 + 6862/15,528 (44.2)
HIV status
Positive 5167/17,691 (29.2)
Negative 12,524/17,691 (70.8)
CD4/mm3, median (IQR) 150 (222)
CD4<150/mm3 217/435 (49.9)
CD4≥150/mm3 218/435 (50.1)
Cured 11,505 (58.5)
Completed treatment 5,425 (27.6)
Death 1,565 (8.0)
Failure 222 (1.1)
Lost to follow-up 560 (2.8)
Transfer 404 (2.1)
CI: Confidence interval, IQR: Interquartile range, PTB: Pulmonary tuberculosis, EPTB: Extra-pulmonary tuberculosis, SNPTB: Smear negative pulmonary tuberculosis, SPPTB: Smear positive pulmonary tuberculosis, HIV: Human immunodeficiency virus, CD4: Cluster differentiation 4, Kg: Kilogram
Outcomes of TB
The incidence (95% CI) of poor outcomes was represented, respectively, by 8.0% (7.5–8.5%) deaths, 2.8% (2.6–3.1%) lost to follow-up, and 1.1% (1.0–1.3%) failure to treatment. Four hundred and four [2.1% (1.9–2.3%)], patients were transferred out. Treatment success was observed in 86.0% of our study population, with 58.5% (57.7–59.1%) cured patients and 27.6% (26.9–29.2%) patients who completed their treatment [Table 1].
Incidence of death among patients treated for TB
During a total follow-up time of 109,328 person-months in 19,681 patients, 1565 persons died, giving a mortality incidence density of 1.43 (95% CI: 1.36–1.50) per 100 person-months. There was a reduction of the cumulative death incidence from 9.9% in 2010 to 6.8% in 2015, P = 0.003. As presented in [Figure 1], the incidence of death was consistently higher in West region compared to North region between 2010 and 2015. Incidence of death was higher in patients recruited in the West region compared to those recruited in the North region (15.7% vs. 3.1%, P < 0.001). Analysis of mortality rate showed that most deaths occurred within the 1st month of treatment, with a crude mortality rate of 50.5% (791/1565 patients) as compared to the 226 (14.4%) patients in the 2nd month, 138 (8.8%) patients in the 3rd month, and 410 (26.2%) patients in the 4th month and thereafter. The median (25th-75th percentile) time of death was 30 (8–98) days.
Figure 1:: Evolution of tuberculosis mortality rate from 2010 to 2015 in West and North Region of Cameroon.
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Predictors of death among patients treated for TB
Kaplan-Maier analysis and Log Rank (Mantel-Cox) test show differences in mortality between sub-groups [Figure 2] and [Figure 3]. When stratified by type of TB, mortality was higher for patients with EPTB [Figure 2] (P < 0.001). When stratified by HIV status, mortality was lowest among HIV negative patients [Figure 3] (P = 0.001). When stratified by age, mortality was higher among patients aged >34 years (P = 0.001). There were no statistical differences after stratification by gender (P = 0.053) and previous TB treatment (P = 0.119).
Figure 2:: Death probability during tuberculosis (TB) treatment according to type of TB.
Figure 3:: Death probability during tuberculosis treatment according to the HIV status.
[Table 2] shows factors associated with death during TB treatment after Cox regression. In univariate analysis, the factors (Hazards ratio [HR] [95% CI]) associated with death during TB treatment were patients recruited before 2012 compared to those recruited after 2012 (P < 0.001). Patients who died during TB treatment were older with a median age (IQR) of 39 (11) years (HR [95% CI], 1.888 [1.702–2.095], P < 0.001]). Patients with the lowest weight included in the 1st quartile died the most during TB treatment (1.779 [1.514– 2.137], P < 0.001). Extra-pulmonary TB (1.713 [1.506–1.949], P < 0.001s), low sputum smear (bacilli load ≥2+: 0.632 [0.565–0.707], P < 0.001), and referred patients (2.050 [1.271–3.306], P = 0.003) were associated with death. Positive HIV status was associated with death during TB (4.557 [4.090–5.078], P < 0.001). A reduction of the CD4 count was associated with death during TB (0.0310 [0.206–0.466], P < 0.001). Retreatment cases (1.069 [0.848–1.349], P = 0571) were not associated with death in our study.
Table 2:: Factors associated with death among patients treated for tuberculosis after Cox proportional hazards modeling in two regions of Cameroon.
Univariate analysis
(95% CI)
HR (95% CI)
Age, years, median (years)
>34 1.888 (1.702–2.095) <0.001 1.479 (1.295–1.688) <0.001
≤34 1
Female 1.101 (0.994–1.219) 0.064 1.471 (1.286–1.683) <0.001
West 0.192 (0.170–0.216) <0.001 2.241 (1.815–2.768) <0.001
≤2012 0.822 (0.744–0.908) <0.001 1.215 (1.073–1.376) 0.002
>2012 1
Form of TB
EPTB 1.713 (1.506–1.949) <0.001 1.723 (1.466–2.026) <0.001
PTB 1
Weight (Kg) 0.980 (0.974–0.986) <0.001
<25th percentile 1.799 (1.514–2.137) <0.001 2.568 (2.133–3.092) <0.001
25th –50th percentile 1.339 (1.118–1.604) 0.002 1.569 (1.298–1.896) <0.001
50th –75th percentile 1.104 (0.919–1.326) 0.289 1.198 (0.991–1.448) 0.062
>75th percentile 1 1
HIV infection 4.557 (4.090–5.078) <0.001 3.739 (3.269–4.276) <0.001
CD4 count/mm3 0.310 (0.206–0.466) <0.001
HR: Hazards ratio, CI: Confidence interval, IQR: Interquartile range, TB: Tuberculosis, PTB: pulmonary tuberculosis, EPTB: Extra-pulmonary tuberculosis, HIV: Human immunodeficiency virus, CD4: Cluster differentiation 4, BMI: Body mass index, Kg: kilogram, m2: Meter2
After multivariate analysis [Table 2], the predictors were: Age >34 years (1.479 [1.295–1.688], P < 0.001), female gender (1.471 [1.286–1.683], P < 0.001), extra-pulmonary TB (1.723 [1.466–2.026], P < 0.001), HIV infection (3.739 [3.269–4.276], P < 001), recruitment in the West region (2.241 [1.815–2.768], P < 0.001), treatment before 2012 (1.215 [1.073–1.376]), P = 0.002, and low weight (1st quartile and 2nd quartile) (2.568 [2.133–3.092], [P < 0.001] and 1.569 [1.298–1.896], P < 0.001), respectively.
The objective of this study was to determine the incidence and predictors of death during TB in two regions of Cameroon. The cumulative incidence of TB death was 8.0%. The predictors of death during TB were: Age, female sex, patients recruited in West Region before 2012, HIV infection, extra-pulmonary TB, and low body weight.
The incidence of death during TB in our study was in the range of 5.0%–9.5% found in literature.[5,11,18-22] Eshetie et al. in the meta-analysis of 34 Ethiopian studies conducted from 2003 to 2016 reported 8.0%[5] and Ejeta et al. reported a rate of 8.1%,[23] as in our study. The incidence of death reached 11.3% in Ukraine,[24] 13.5% in Ghana,[6] 16.6% in Nigeria,[7] and 20.2% in Southwest Ethiopia,[8] which was higher than the rate found in our cohort. This could be due to the increase in the prevalence of multidrug-resistant TB and HIV infection in recent decades.[5,25] In Nigeria, the proportion of case fatality was well above twice that found in our cohort. This could be explained by the high proportion of TB/HIV coinfection which was 39.8% (with only 6.3% on ART) compared to 29.2% (up to 46.1% of them on ART in 2009[14]) in our cohort and also due to Boko Haram insurgency in Kano state, where that study was done, leading to a large number of displaced and vulnerable populations.[7,26] In Cameroon HIV positive patients, the death rate was 3.7% among those with CD4 above 200/mm3 and 13% among those with CD4 below 200/mm3 (P < 0.02).[13] On the other hand, the incidence of death was low in Turkey (2.4%) compared to our study.[27] This could be explained by the differences in the study population, which was only patients with bacteriologically confirmed pulmonary TB, with 92.6% successful treatment outcome. In that Turkish study, treatment outcome was successful in young and educated pulmonary TB patients who had no drug resistance, no previous treatment history, and no comorbidities.
Predictors of death during TB found in our study were: Age, female sex, recruitment before 2012 in the West region, extra-pulmonary TB, people living with HIV, and underweight. Dangisso et al. revealed that people over the age of 34 were twice as likely to die from TB.[28] These results are similar to those of our study, in which the median age was 34 years. This may be due to the increase of comorbidities with age as it was reported in that Ethiopian study. Studies carried out in South Africa and Southwest Ethiopia found that female sex was associated with death during TB from 2010 to 2012 as in our study.[8,20] Comparable results were described in South Asia and Zambia.[29,30] Low body mass indexes were factors associated with death during TB after multivariate analysis, as found in our study.[19,31,32] This could be due to an advanced disease caused by delay in diagnosis related to poor access and utilization of healthcare, poor socio-economic status and social behaviors of women. Notice that 60% of our study population were registered in the North of Cameroon where climate was worse and malnutrition was highest. Regarding HIV, this result was similar to the findings of many other studies.[5,18,26] Ogyiri et al. in Ghana found that people living with HIV (21.8% vs. 5.5%) were more likely to die during TB.[33] The severity of immunodeficiency among TB-HIV coinfected patients has been described as a predictor of decreased survival and was likely the main determinant of early death in HIV-infected PTB patients despite their use of antiretroviral therapy.[13,34] As previously shown in another Cameroonian study, HIV infection is a determinant of extrapulmonary TB.[35] Kapata et al. also found that determinants of TB/HIV coinfection were female sex and extrapulmonary TB.[29] The diagnosis of EPTB was difficult to confirm in regional facilities where there was lack of medical doctors and specialists in our setting. We could easily have differential diagnosis such as cancer and other opportunistic diseases being treated as TB, which resulted certainly to death without adequate treatment, and then registered as TB death incorrectly.
Being diagnosed with TB before 2012 was a predictor of death, while the case fatality decreased progressively from 2010 to 2015 in our study. We speculated that TB patients diagnosed after 2012 died less than those diagnosed before, certainly because of the decrease of HIV infection since 2000 and the systematic use of antiretroviral therapy for people living with HIV since 2013 in Cameroun.[36] The prevalence of HIV in Cameroon was 5.1% in 2010 and 4.8% in 2016.[15,37] Cameroon notified 89,445 persons on ART in 2010, 122,783 people on ART in 2012 and 168,431 persons on ART in 2015.[15] In other words, the number of people on ART approximately doubled during our study period.
Some limitations of our study include the missing data, which is expected for a study with data collected from registers. Missing data on height did not permit us to assess the nutritional status of the study population. This retrospective study did not allow us to obtain specific socioeconomic, demographic, clinical, radiological, and biological information that could possibly predict mortality during TB treatment. The main strength of our study lies in its large sample size which increased our statistical power to reliably characterize the predictors of mortality.
The incidence (95% CI) of death during TB was 8.0% (7.5–8.5%) in two regions of Cameroon. The density incidence of death among patients treated for TB was 1.43 (95% CI: 1.36–1.50) per 100 person-months. Predictors of death among patients treated for TB were: Age >34 years, female gender, extra-pulmonary TB, HIV infection, recruitment in the West region, treatment before 2012, and low weight (1st quartile and 2nd quartile). Early detection and adequate management of people living with HIV would reduce mortality during TB.
Patient's consent not required as patients identity is not disclosed or compromised.
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Dangisso MH, Woldesemayat EM, Datiko DG, Lindtjørn B. Long-term outcome of smear-positive tuberculosis patients after initiation and completion of treatment: A ten-year retrospective cohort study. PLoS One. 2018;13:e0193396.
Kapata N, Chanda-Kapata P, Michelo C. The social determinants of tuberculosis and their association with TB/HIV co-infection in Lusaka, Zambia. 2013. Med J Zambia. 40:49-54. Avaiable from: https://www.ajol.info/index.php/mjz/article/view/110518 [Last accessed on 2020 Oct 03]
Ghose B, Zhaohui C, Zhifei H. Understanding the social determinants of TB and HIV in South Asia. PeerJ Prepr. 2014;2:e579.v1.
Melese A, Zeleke B. Factors associated with poor treatment outcome of tuberculosis in Debre Tabor, Northwest Ethiopia. BMC Res Notes. 2018;11:25.
Khazaei S, Hassanzadeh J, Rezaeian S, Ghaderi E, Khazaei S, Hafshejani AM, et al. Treatment outcome of new smear positive pulmonary tuberculosis patients in Hamadan, Iran: A registry-based cross-sectional study. Egypt J Chest Dis Tuberc. 2016;65:825-30.
Ogyiri L, Lartey M, Ojewale O, Adjei AA, Kwara A, Adanu RM, et al. Effect of HIV infection on TB treatment outcomes and time to mortality in two urban hospitals in Ghana-a retrospective cohort study. Pan Afr Med J. 2019;32:206.
Kuaban C, Pefura-Yone E, Bava D, Onana I. Early mortality in new patients on treatment for smear positive pulmonary tuberculosis in Yaounde-Cameroon. 2011. Health Sci Dis. 12:1-7. Avaiable from: https://www.hsd-fmsb.org/index.php/hsd/article/view/21 [Last accessed on 2021 Sep 20]
Pefura-Yone EW, Kengne AP, Balkissou AD, Onana IN, Endale LM, Amadou D, et al. Clinical forms and determinants of different locations of extra-pulmonary tuberculosis in an African country. Indian J Tuberc. 2013;60:107-13.
Murray CJL, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: A systematic analysis for the global burden of disease study 2013. Lancet. 2014;384:1005-70.
CNLS. Rapport Annuel 2010 des Activites du Programme National de Lutte Contre le SIDA. Recherche.
The accuracy of a mobile phone application (Wulira… September 27, 2020
Prevalence and predictors of pulmonary fungal… August 7, 2021
Predictors and outcomes of COVID-19 patients with… October 22, 2021
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Published by Scientific Scholar on behalf of Pan African Thoracic Society.


text:
Q: Scala Authorization header - Akka HTTP IllegalArgumentException I'm trying in Scala to make a request to send a user/pass:
def makeRequestWithRadiusHeader(header: String) = {
    val urlEncHeaderVal = java.net.URLEncoder.encode(s"Basic $header", "utf-8")
    val request = exampleNmsRequest() ~> addHeader("Authorization", urlEncHeaderVal)

    makeRequest(request)
  }

where header is "user:password" and on addHeader I get an error like this:
java.lang.IllegalArgumentException: Illegal HTTP header 'Authorization': Invalid input '%', expected token68-start, '=', OWS or 'EOI' (line 1, column 11): Basic+user%3Apassword

If I try without encoding, I get the same error with ':'

A: I've solved it giving to the function makeRequestWithRadiusHeader a base64 converted parameter.
val validRadiusHeader = BaseEncoding.base64().encode("aladdin:OpenSesame".getBytes(Charsets.UTF_8))
val response = makeRequestWithRadiusHeader(validRadiusHeader)

This way it works fine. It is the way Basic access authentication works.


text:
Sacramento community leaders call for changes to law enforcement culture
ABC10 News at 6
The ABC10 News team has the latest local news and weather, including a recap of everything that happened today in our communities.
Published: 5:59 PM PST January 24, 2023
Updated: 5:59 PM PST January 24, 2023


text:
Jermont Terry
Jermont Terry joined the CBS 2 team in October 2019. He's born and raised on Chicago's South Side. He's happy to return home to report on his community after 18 years of uncovering stories across the country.
Most recently, Jermont worked as the lead night side reporter at WDIV-TV, the NBC station, in Detroit. While there, Jermont led breaking news coverage and broke the story about a fetal remains left behind in a defunct funeral home. Prior to moving to Detroit, Jermont worked as the chief investigative reporter at WTMJ-TV in Milwaukee. His career has spanned stations across the east coast and south working as an investigative and general assignment reporter at WXII-TV, Winston-Salem, NC, WKYT-TV, in Lexington, and WLFI-TV, West Lafayette, IN.
Jermont graduated from the University of Illinois. He earned his Bachelors of Science in broadcast journalism from the College of Communications. Go Illini!
Jermont is an award-winning journalist. The Wisconsin Broadcasters Association awarded Jermont with the Best Hard News Investigation and Best Live On-Scene Reporting in the state. The Milwaukee Press Club honored Jermont with a first place award for Best Investigative Series.
Throughout his career he has been honored with numerous awards including an Associated Press award for Best Enterprise/Investigative Story. Also his work and contributions at WKYT and WXII led to the prestigious Edward R. Murrow award.
Jermont is an active member of the National Association of Black Journalists and the Investigative Reporters and Editors. When he's not working Jermont loves relaxing and taking vacations.
He's a proud Chicagoan, who grew up in Beverly and graduated from Morgan Park High School.
Jermont is always looking to uncover the truth and tell the stories of the people.
Follow Jermont Terry on
Latest From Jermont Terry
Violent Crime On CTA Buses, Trains Is At A Six-Year High And Is A Growing ProblemA search continued Friday night for two men who stabbed three CTA riders on the Red Line subway downtown. As CBS 2's Jermont Terry reported, the attack highlights a growing problem with crime on the Chicago Transit Authority.
Dog Recovering After Paws Are Shocked At Diversey And Orchard In Lakeview -- And It's Happened To Other Dogs TooA yellow Labrador retriever was recovering Thursday after his paws were shocked while he was simply walking down the street.
Water Main Break Leaves Streets Flooded And People Trapped At Home In Grand Crossing, And Neighbors Say City Crews Didn't Take Action For HoursWith the freezing temperatures in Chicago lately, a water main break is the last thing anyone wants to hear about. But one happened in the Grand Crossing neighborhood, and it has left a watery mess that has caused frustration and backup.
Investigation Shows 6-Year-Old Damari Perry Died Of Hypothermia, Body Was Burned After He DiedAn autopsy showed that the body of 6-year-old Damari Perry was naked and partially burned upon being found dumped in Gary, Indiana, and the likely cause of his death was hypothermia.
DCFS Had Been In Touch With 6-Year-Old Damari Perry's Family Before He Was Killed; His Mother And Siblings Are Now Charged In His DeathDamari Perry was just 6 years old, and prosecutors said he was punished – forced to take an ice-cold shower by his mother – before his death last week. As CBS 2's Jermont Terry reported, it turns out that the Illinois Department of Children and Family Services had been in touch with Damari's family before.


text:
module FreeAgent

  # The Base class for any FreeAgent resource.
  #
  # == Dynamic Finders
  #
  # Like ActiveRecord, this class support dynamic finders.
  # You can use dynamic finders to search a resource by any of its attributes.
  #
  #   class Contact < Base
  #   end
  #
  #   Contact.find_by_email 'email@example.org'
  #   Contact.find_by_username_and_email 'weppos', 'email@example.org'
  #
  # However, there's one important caveat we should mention.
  # This feature is not very efficient and the more records you have,
  # the longer the query it takes.
  #
  # This is because record filtering is performed client-side.
  # The library first loads and instantiate all records, then it filters them
  # applying given criteria.
  #
  class Base < ActiveResource::Base

    # = Active Record Dynamic Finder Match
    #
    # Refer to ActiveRecord::Base documentation for Dynamic attribute-based finders for detailed info.
    #
    class DynamicFinderMatch
      def self.match(method)
        finder       = :first
        bang         = false
        instantiator = nil

        case method.to_s
        when /^find_(all_|last_)?by_([_a-zA-Z]\w*)$/
          finder = :last if $1 == 'last_'
          finder = :all if $1 == 'all_'
          names = $2
        when /^find_by_([_a-zA-Z]\w*)\!$/
          bang = true
          names = $1
        when /^find_or_(initialize|create)_by_([_a-zA-Z]\w*)$/
          instantiator = $1 == 'initialize' ? :new : :create
          names = $2
        else
          return nil
        end

        new(finder, instantiator, bang, names.split('_and_'))
      end

      def initialize(finder, instantiator, bang, attribute_names)
        @finder          = finder
        @instantiator    = instantiator
        @bang            = bang
        @attribute_names = attribute_names
      end

      attr_reader :finder, :attribute_names, :instantiator

      def finder?
        @finder && !@instantiator
      end

      def instantiator?
        @finder == :first && @instantiator
      end

      def creator?
        @finder == :first && @instantiator == :create
      end

      def bang?
        @bang
      end
    end

    class << self

      protected

        def method_missing(method_id, *arguments, &block)
          if match = DynamicFinderMatch.match(method_id)
            attribute_names = match.attribute_names
            if match.finder?
              find_by_attributes(match, attribute_names, *arguments)
            elsif match.instantiator?
              find_or_instantiator_by_attributes(match, attribute_names, *arguments, &block)
            end
          else
            super
          end
        end

        def find_by_attributes(match, attributes, *args)
          conditions = Hash[attributes.map {|a| [a, args[attributes.index(a)]]}]
          result = all.select do |record|
            conditions.all? { |k,v| record.send(k) == v }
          end
          result = result.send(match.finder) if match.finder != :all

          if match.bang? && result.blank?
            raise ActiveResource::ResourceNotFound, 404, "Couldn't find #{self} with #{conditions.to_a.collect {|p| p.join(' = ')}.join(', ')}"
          else
            result
          end
        end

        def find_or_instantiator_by_attributes(match, attributes, *args)
          record = find_by_attributes(match, attributes, *args)

          unless record
            conditions = Hash[attributes.map {|a| [a, args[attributes.index(a)]]}]
            record = new(conditions)
            yield(record) if block_given?
            record.save if match.instantiator == :create
          end

          record
        end

    end

    def respond_to?(method_id, include_private = false)
      if DynamicFinderMatch.match(method_id)
        return true
      end

      super
    end

  end

end


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text:
Madonna Just Said Something Mind-Numbing About Gun Control And Police
Photo by Andy Montes de Oca on Unsplash
Donald Trump broke the brains of many in Hollywood.
Increasingly more celebrities have gone on deranged rants about Trump and politics more broadly.
Now Madonna just said something mind-numbing about gun control and the police.
Many celebrities who have achieved fame and fortune in some form of entertainment feel as though their success bestows upon them special knowledge in other avenues of life.
That's why so many actors and musicians opine about politics without having the slightest clue of what they're talking about.
Long-time pop diva Madonna is a perfect example of this.
In 2017 after Donald Trump's inauguration, Madonna got a visit from the secret service when she said, "I have thought an awful lot about blowing up the White House."
Her political takes have somehow gotten even more unhinged since then.
Madonna recently released an Instagram video advocating for gun control.
In the video she says:
"Have you heard of this new vaccination for America? It's going to keep us all alive. It's going to keep us all safe…It's called gun control, okay? It's called gun safety, all right? New vaccination. It should be mandatory for all citizens."
Gun control is supposed to be the "new vaccination" that saves America.
This is the same tired plea from the gun grabbers that constantly gets recycled.
In a follow-up Instagram post to the video, Madonna said:
"Yes-people kill people, not guns. But the vast majority of people are not enlightened and guns are too easy to own. If they were outlawed then no one would feel the need to own a gun to protect themselves from those who have guns."
Madonna is using the logic of a seven-year-old.
The overwhelming majority of gun owners are law-abiding and responsible.
And the countless instances of gun ownership acting as a deterrent for criminals are not considered by the gun control zealots.
Madonna's vapid take on guns is partly why gun sales continue to rise; the reality on the ground doesn't match the rhetoric of the gun grabbers.
Madonna also commented on the police and recent shootings that have roiled activists on the Left.
She wrote:
"As for Police killing innocent children. Shooting and suffocating and brutalizing innocent people…………They should go immediately to jail for the rest of there [sic] lives. No trial, no corrupt justice system."
Madonna wants to get rid of due process of law.
Regressive leftists like Madonna have zero concept of rights and due process protects the most vulnerable in society from abuses of power.
Unfortunately, many liberals have abandoned civil liberties in favor of fascistic mob rule.
For example, the ACLU will no longer defend the rights of people they find abhorrent.
Corporate press outlets have published multiple pieces about how free speech is "problematic."
Other so-called liberals have expressed envy over the Chinese Communist Party's model of governance.
And useful idiots like Madonna are being used to propagate ideas that roll back American freedoms.
Tags culture Gun Control Madonna
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text:
Yuri: An Indepth Look at Women in Love
A look at the tropes used in Yuri.
Bookworm52 Feb 16, 2014
Gay/bi men's opinions on yaoi (or other works that center around M/M relationships yet are produced primarily by and for women)?
Do you feel this genre often fetishizes/objectifies the males depicted? – moreover: do you feel objectified yourself? Offended? How accurate are the portrayals in these manga/anime? Is this true LGBT representation or does it actually serve to hinder promotion of LGBT rights in some ways? Would you feel uncomfortable around someone who self-identifies as a "fujoshi?"
Also: What about shounen-ai?
I think this is incredibly interesting, and I'd love to know more about it. But it feels very much like a direct question as opposed to a topic. My recommendations would be to rephrase it so that an article could be written about it, and define some of the words which people may not know. – Connor Gregorich-Trevor 5 years ago
Agreeing with Connor, rephrasing this would help the future writer to be guided into NOT writing commentary. Topic title should be like Yaoi a representation of gay relationships or romanticized fantasy... and are we talking about yaoi and sexual content? – Jill 5 years ago
I think women objectify men in gay fetish porn the same way men objectify women in porn. And I agree that people in these portrayals are rarely true to how people actually are. This can set LGBT rights back in same ways, especially when gay men are always sexy with six packs and not just regular, ordinary men. I don't know much else about what you are asking, so I can't help much with this, but those are my thoughts on the objectification of gay people. I am not really offended by it, but I think it's detrimental to peoples' self-esteem and LGBT rights to a degree. – Robyn McComb 5 years ago
I'm wondering if men who are into M/M works truly appreciate yaoi or shounen-ai, due to how characters are represented in these works. Or if they also appreciate bara more, which is produced primarily by gay men for a gay audience. Personally, as someone who identifies as male and queer, I am into yaoi, shounen-ai, and bara, but I find it problematic in how some characters and relationships are portrayed. I think that a certain type of body is being objectified in each genre, but that is how these genres cater to their respective audience. It can be damaging to those readers/viewers who identify as LGBT, and may not fit that specific portrayal. Some shounen-ai works I have read/watched do a decent job in showing how gay relationships form, and touch upon the struggle that gay or bisexual people face in coming to terms with their sexuality and identity. – Sean Navat Balanon 5 years ago
I think it's helpful, as someone who likes shounen-ai, to reflect on how these young women came to like genres like yaoi. I'd argue that it's due to the popularity of shounen manga and the intense male relationships within them (take NaruSasuNaru, or Light x L). Because these relationships never become romances, fans find other series to fill in for their characters. Popular male on male romances adhere to many tropes, many of which can be traced back to the original shounen manga the characters are derived from. – ChristelleMarie 5 years ago
perhaps it would be best done as a comparison piece between the portrayal of gay men and other fetish images of both men and women. Classic daydreams of both men and women that stereotype others. – Jutor 5 years ago


text:
Movie Review: Logan
March 5, 2017 T.J.
Perfect trailers are difficult to surpass. Though we live in an era where movie teasers have become a science, generally able to make almost any flick seem watch-worthy, there are rare gems that continue to shine brightly.
Watchmen in particular comes to mind; it had a fantastic trailer that I still enjoy watching despite the film that turned out to be a grave disappointment (cliche: The book was better).
The Logan trailer featuring Johnny Cash's cover of Hurt is what I'd consider a perfect trailer, and it underscores just how impactful music choice can be. If you haven't seen it, please witness it below.
Logan is a bit of an aberration amongst comic book movies in that it doesn't lift any particular comic storyline directly. Yes, it is clearly influenced by Old Man Logan, a post-apocalyptic What If? story penned by Mark Millar, but plot and rights complications prohibit a direct adaptation.
Instead, Logan takes the spirit of Old Man Logan by placing everyone's favorite Canadian mutant in the not-so-distant future, bereft of his team of fellow mutants and his reasons to fight. Real-world news that both Hugh Jackman and Patrick Stewart are saying goodbye to their X-Men characters with this film add to what is already an emotionally-charged film.
Minor spoilers ahead.
Though the trailer does an excellent job drawing you in and setting up the story, it does not prepare you for the raw emotion of a time-ravaged Charles (Professor X, now 90+) and Logan (well over 100). Adult fans of the X-Men will likely find Charles' struggles with an aging mind particularly poignant, and Logan's initial reticence to charge once more into the fray is all too easily understood.
And this is a Wolverine film for adults. Marketed at the R-rating, it is more violent than past films (and celebrates the f-bomb quite flagrantly), but it also rises above the standard formula of superhero films and stands as an excellent film, period. The mentor/friendship chemistry between Jackman and Stewart has never been more present, and solid supporting actors help share the weight of such a heavy story.
In the end, I find it satisfying that Wolverine's journey over the last 17 years (inclusive of the X-Men content) has ultimately matured with its fans. Themes that would not much appeal to the 18 year old version of me that saw X-Men in the theater now stab me in the heart, and I'm betting that I'm not alone.
Having said that, in following the films for that long I'll admit it wasn't quite the send-off I had hoped for (plot reasons, not film quality)--but in the end I'm relieved that it was an admirable send-off just the same.
The fact that Johnny Cash's Hurt has risen to the top of my playlists is simply a bonus.
In Movie Reviews, Comics


text:
Devin McCaslin Biography
JAAA Instructions to Authors
JAAA Subscription Rates & Information
JAAA Editorial and Contact Information
JAAA Archives
Devin McCaslin is an associate professor at the Vanderbilt Bill Wilkerson Center in Nashville. He received a master's degree in audiology from Wayne State University and a PhD in hearing science from The Ohio State University.
Following the completion of his PhD, McCaslin took a position as a clinical audiologist at the Dayton Veteran's Administration Hospital for two years and then joined the Division of Audiology at Henry Ford Hospital in Detroit. McCaslin joined the faculty at the Bill Wilkerson Center in the Vanderbilt School of Medicine in 2004. Here he is the associate director of Adult Audiology and codirector of Vestibular Sciences.
McCaslin maintains a clinical practice and is an instructor in both the doctor of audiology and PhD programs. His major academic, clinical, and research interests relate to clinical electrophysiology, tinnitus, and vestibular assessment.


text:
Four words to listen for that could indicate a scam
Four words to listen four that could indicate a scam
MILWAUKEE (WITI) -- FOX6's Contact 6 says there are four words to listen for when someone is trying to sell you an investment. One large group of investigators could have saved a million dollars if they had known that those words, in most cases, indicate a scam.
"He convinced them that he was going to make them a ton of money," U.S. Postal Inspector Hope Cerda said.
He is Hector Gallardo -- a U.S. stock broker who targeted investors in Bolivia.
"This individual went down to Bolivia, you know, wined and dined them basically and told them that everything was guaranteed and they can make money on the stock exchange and they just had to send the money and he would take care of everything for you. He told them that they could get basically a rate of return of 18% guaranteed," Cerda said.
300 victims sent Gallardo -- who was born in Argentina -- a little more than a million dollars.
"He was very charismatic. He knows the language. He was able to befriend these people. They were enticed by the fact that he was from South America and that he had made it in the United States so they figured that he could help them make it," Cerda said.
The people who invested with Gallardo were not rich.
"All of them are working class people. They don`t have a lot of money. They were looking to better themselves. They weren`t looking to make millions of dollars, they were just looking to help their families out," Cerda said.
Authorities say Gallardo deposited their money in his own bank account.
"He took the money and went on vacations. He had nice cars, he had a beautiful home. He just spent the money anyway he wanted to make his life better," Cerda said.
The takeaway from this case:
"If someone is guaranteeing you a rate of return that is much higher than you know to be factual, it most likely is a scam," Cerda said.
"Guaranteed rate of return" are four words to listen for -- and when you hear them, run in the other direction.
Gallardo was convicted and sentenced to five years in prison, and ordered to pay almost $900,000 in restitution.