Help Nature Sustain Its Energy with Solar Energy Training ? Article ...

You must have learned in school that solar energy comes directly from the sun. It can be used for different purposes, the main reason being to conserve other forms of energy.

You must have learned in school that solar energy comes directly from the sun. It can be used for different purposes, the main reason being to conserve other forms of energy. Over the last decade or so, a number of companies and residences have started using solar energy. With the advancement in technology, companies need educated individuals for installing solar power. Companies wherein they teach people of all skill levels conduct solar energy training. Regardless of whether you are a novice or an expert, enrolling in this training can enable you to help nature sustain its natural energy.

You might wonder why there is a need to undergo solar training. One of the reasons can be said that you can help conserve energy, which can further be used for different purposes. With the talks of global warming and other such issues, it has become essential to save energy. The rays that come from the sun in one day can be used to supply power for the next five years. Professionals offer the solar energy training. You can search for ideal ones over the Internet by conducting research. Go through their reviews and testimonials so as to learn about the reliability of their courses.

The companies offer you a chance to register online. While at it, you can find all the topics that will be covered in the course duration. The range of courses differs and you can choose one as per your convenience. Some of the topics, which will be taught, include entry-level PV design and installation, advance PV solar installation training, AE agency training and many more. Upon completion of the course, you will be required to pass the NABCEP exam, which is the acronym for North American Board of Certified Energy Practitioners.

The certification course will open several doors for you to pursue career in the energy industry. This particular industry is growing more rapidly than any other field. It can be said that the certification course is your golden ticket to future glory. The individuals offering solar energy training are professionals who have over time gained a lot of information on the subject. They strive hard to make sure that the lectures are engaging to students and they go home with a determination in their mind to do their bit to conserve energy. Becoming a part of renewable energy education will not only make you a responsible citizen, but also a skilled worker.

The fees charged for the training are affordable. There is a lot of information to be gained by enrolling for solar energy training. You can surf online and choose a convenient schedule for lectures. Also, there are discounts offered by the professionals on courses, which are for limited duration. Taking advantage of this opportunity can help you to save money and at the same time learn a lot about conserving energy. It is advisable that you go online today and search all the necessary details about the course.

Resources:
Kelly Smith is the author of this article on solar energy education. Find more information, about solar panel training here

Source: http://companieslist.org/reference-education/help-nature-sustain-its-energy-with-solar-energy-training/

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Odyssey successfully positioned for new Mars Rover's landing, NASA says

NASA announced the 11-year-old Mars Odyssey, which recently suffered a malfunction, has been successfully positioned to provide confirmation of Curiosity's August 5?landing.

By Space.com Staff / July 25, 2012

NASA's Mars Odyssey spacecraft passes above Mars' south pole in this artist's concept illustration. The spacecraft has been orbiting Mars since October 24, 2001. Image released October 28, 2003.

NASA/JPL-Caltech

Enlarge

NASA has successfully moved one of its Mars-orbiting spacecraft into a new position to provide prompt confirmation of the upcoming Aug. 5 landing of the new Curiosity rover on the Red Planet.

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The 11-year-old?Mars Odyssey probe performed a six-second thruster burn Tuesday (July 24) that nudged it six minutes ahead in its orbit, NASA officials said. The manuever placed Odyssey in a prime spot to receive signals from the Curiosity rover when it streaks toward the Martian surface, and to relay news of the rover's landing back to Earth.

"Information we are receiving indicates the maneuver has completed as planned," Mars Odyssey project manager Gaylon McSmith, of NASA's Jet Propulsion Laboratory in Pasadena, Calif., said in a statement. "Odyssey has been working at Mars longer than any other spacecraft, so it is appropriate that it has a special role in supporting the newest arrival."

Odyssey's comeback

The move marks something of a comeback for Odyssey, which in early June suffered a malfunction on one of its reaction wheels, instruments that help control the probe's orientation in space. The glitch caused Odyssey to go into a precautionary safe mode on July 11, which in turn affected its orbit.

As a result, officials weren't sure whether Odyssey would be in the right spot during the 1-ton Curiosity rover's touchdown. Without the corrective engine burn, Odyssey would have arrived over Curiosity's landing site ? the enormous Gale Crater ? about two minutes after the rover touched down, officials said.

Curiosity, the centerpiece of NASA's $2.5 billion Mars Science Laboratory (MSL) mission, will investigate whether the Gale area is, or ever was, capable of supporting microbial life.

Its landing is inspiring perhaps more nervousness than most other planetary touchdowns. Because Curiosity is so big, MSL engineers had to devise a new landing method for the rover. They settled on a rocket-powered sky crane, which will lower Curiosity to the Martian surface on cables before flying off and intentionally crash-landing a short distance away. [How Curiosity's Nail-Biting Landing Works (Pictures)]

A communications relay

Odyssey is uniquely capable of relaying the landing news in real time. Two other Mars orbiters, NASA's Mars Reconnaissance Orbiter and the European Space Agency's Mars Express, will receive transmissions from Curiosity's spacecraft, but they'll send the communications along to Earth after a delay of several hours, officials said.

And Earth will set below the Martian horizon before Curiosity touches down, meaning the MSL spacecraft won't be able to beam signals home directly.

The upshot of Odyssey's successful maneuver is that the Curiosity team should learn of the landing's outcome by 10:31 p.m. Pacific time Aug. 5 (1:31 a.m. Eastern time Aug. 6).

Odyssey began science operations in February 2002, and it has now worked at Mars longer than any other mission in history. The probe created the first global maps of chemical and mineral distribution on Mars, and its observations led to the discovery of vast amounts of water ice buried under the planet's surface.

The spacecraft has also served as a communications relay station for NASA's Spirit and Opportunity rovers and the Phoenix lander.

Follow SPACE.com for the latest in space science and exploration news on Twitter @Spacedotcom?and on Facebook.

Copyright 2012 SPACE.com, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Source: http://rss.csmonitor.com/~r/feeds/csm/~3/zy5smZRTURc/Odyssey-successfully-positioned-for-new-Mars-Rover-s-landing-NASA-says

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Netflix chosen by many, but liked by few, says study

6 hrs.

Despite being used by more than 80 percent of the respondents in a new Consumer Reports survey, Netflix video streaming service?doesn't seem to be very well-liked. Users mainly criticized its poor selection and did not see it as a viable option for replacing cable TV and movie rentals.

Over 15,000 people were surveyed by Consumer Reports for the study, and while it doesn't really bear out any new information, it does indicate that people understand the shortcomings of these services.

With Netflix, predictably, it's the selection. Who hasn't tried to find something to watch some night, only to spend it scrolling through endless early-2000s movies and obscure documentaries? One respondent noted that the latest movie he could find with George Clooney in it was 10 years old. Even for $8 a month, that's pretty shabby.

The larger take-away is that there still just?isn't a valid replacement for cable TV and movie rentals. You can go cheap with Netflix or Hulu Plus, but those are far from an all-access pass. You can pay per episode with Vudu or iTunes, but you may end up spending $30 just to watch a single season of a single show.?And independent movie rental places have a great selection and helpful staff, but no one wants to bet they'll be around in a couple years.

For now it seems people are satisfied to pay their money and get their cable, and then switch on the Roku or Apple TV when there's nothing good on. But given the amount of dissatisfaction with any given?part of this arrangement, be it cost, selection or convenience, the next few years may see more people than ever trying to cut the cord. Meanwhile, Netflix will take the abuse and somehow still maintain a stranglehold on its subscribers. Maybe it's Stockholm Syndrome.

Devin Coldewey is a contributing writer for NBC News?Digital. His personal website is coldewey.cc.

Source: http://www.technolog.msnbc.msn.com/technology/technolog/netflix-chosen-many-liked-few-says-study-912813

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5? years for Ore. woman who got $2.1M bogus refund

SALEM, Ore. (AP) ? A 25-year-old woman who duped the state of Oregon into giving her a $2.1 million tax refund pleaded guilty Tuesday and was sentenced to 5 1/2 years in prison.

Krystle Marie Reyes, of Salem, entered guilty pleas to one felony count of tax evasion and three counts of felony fraud. She had faced eight felony charges.

Reyes' court-appointed lawyer, Gale Rieder, said her client faced "overwhelming" evidence, The Oregonian reported (http://is.gd/hiVixm ).

Rieder said her client "wanted to take responsibility for what she'd done."

"She's remorseful and saddened by the impact on her family," the lawyer said. "She has no criminal history."

The woman received the refund on a debit card and spent about $150,000 before twice reporting the card lost or stolen. At that point the ruse was discovered. The state has recovered about $1.9 million of the money.

An Oregon Department of Revenue spokesman said Tuesday that the findings of an internal agency audit would be released Wednesday.

Reyes filed an electronic tax return in late January via Turbo Tax, erroneously reporting earnings of more than $3 million, authorities have said. Her request for a $2.1 million refund was initially red-flagged by an automated system.

The Oregonian quoted from a 24-page search warrant affidavit regarding what happened next.

The return was set aside for review by processing staff and managers for potential fraud. But "some time later," the affidavit said, a Revenue employee overrode the flagged payment and the refund was issued.

By policy, three agency employees are required to verify the override, the newspaper said. However, according to the affidavit, no one responsible for reviewing the return opened the file to look at it or looked at the W-2 form Reyes filed.

Reyes previously worked at retirement facilities or senior care homes and reported income of less than $15,000 per year in 2009 and 2010, records show.

Before her June 6 arrest, Reyes' spending spree included about $1,800 in cash to buy a 1999 Dodge Caravan and spending $851 on tires and wheels.

The affidavit says other purchases included a queen-sized air mattress, a deep fryer, an air conditioner and a cream and gray floral rug. She bought a sofa and recliner with brown leather trim.

Andrew Campbell, a senior assistant state attorney general who filed the charges against Reyes, declined to comment on Tuesday's plea deal.

___

Information from: The Oregonian, http://www.oregonlive.com

Source: http://news.yahoo.com/5-years-ore-woman-got-2-1m-bogus-040500080.html

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Did Chick-fil-A Pretend to Be a Teenage Girl on Facebook? [Chick-Fil-A]

Chick-fil-A, home of chicken-loving bigots, is in the middle of a PR nightmare. After Chick-fil-A's COO admitted to being anti-gay, the Jim Henson Company (bless their heart) pulled their toys from Chick-fil-A's kids meals. Only Chick-fil-A claimed the toys were pulled because of a "possible safety issue". That, of course, is a complete lie. A lie that the company may be propagating with fake Facebook accounts of Chick-fil-a sympathists. More »


Source: http://feeds.gawker.com/~r/gizmodo/full/~3/6DTEfi9Hmlw/chick+fil+a-got-caught-pretending-to-be-a-fake-teenage-girl-on-facebook

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Apple Shipped 1.3M Apple TVs In Q3 2012, Still Calls It A Hobby

apple tv"We are not going to keep products around we don't believe in," said Apple CEO Tim Cook in regards to the Apple TV on today's earnings call. He also stated that Apple still considers the product a hobby although Apple keeps at the project because they stated "it will lead us [Apple] somewhere." Apple is very happy with Apple TV's growth. The company shipped around 4 million so far during this fiscal year with 1.3 million units over the third quarter -- not so bad for a hobby.

Source: http://feedproxy.google.com/~r/Techcrunch/~3/9Sy9deV3V1o/

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NASA: Strange and sudden massive melt in Greenland

These undated handout images provided by NASA shows the extent of surface melt over Greenland?s ice sheet on July 8, left, and July 12, right. Measurements from three satellites showed that on July 8, about 40 percent of the ice sheet had undergone thawing at or near the surface. In just a few days, the melting had dramatically accelerated and an estimated 97 percent of the ice sheet surface had thawed by July 12. In the image, the areas classified as ?probable melt? (light pink) correspond to those sites where at least one satellite detected surface melting. The areas classified as ?melt? (dark pink) correspond to sites where two or three satellites detected surface melting. Nearly every part of the massive Greenland ice sheet suddenly and strangely melted a bit this month in a freak event that concerned scientists had never witnessed before. NASA says three different satellites saw what it calls unprecedented melting from July 8 to July 12. Most of the thick ice remains, but what was unusual was the widespread area where some melting occurred. (AP Photo/Nicolo E. DiGirolamo, SSAI/NASA GSFC, and Jesse Allen, NASA Earth Observatory

These undated handout images provided by NASA shows the extent of surface melt over Greenland?s ice sheet on July 8, left, and July 12, right. Measurements from three satellites showed that on July 8, about 40 percent of the ice sheet had undergone thawing at or near the surface. In just a few days, the melting had dramatically accelerated and an estimated 97 percent of the ice sheet surface had thawed by July 12. In the image, the areas classified as ?probable melt? (light pink) correspond to those sites where at least one satellite detected surface melting. The areas classified as ?melt? (dark pink) correspond to sites where two or three satellites detected surface melting. Nearly every part of the massive Greenland ice sheet suddenly and strangely melted a bit this month in a freak event that concerned scientists had never witnessed before. NASA says three different satellites saw what it calls unprecedented melting from July 8 to July 12. Most of the thick ice remains, but what was unusual was the widespread area where some melting occurred. (AP Photo/Nicolo E. DiGirolamo, SSAI/NASA GSFC, and Jesse Allen, NASA Earth Observatory

(AP) ? Nearly all of Greenland's massive ice sheet suddenly started melting a bit this month, a freak event that surprised scientists.

Even Greenland's coldest and highest place, Summit station, showed melting. Ice core records show that last happened in 1889 and occurs about once every 150 years.

Three satellites show what NASA calls unprecedented melting of the ice sheet that blankets the island, starting on July 8 and lasting four days. Most of the thick ice remains. While some ice usually melts during the summer, what was unusual was that the melting happened in a flash and over a widespread area.

"You literally had this wave of warm air wash over the Greenland ice sheet and melt it," NASA ice scientist Tom Wagner said Tuesday.

The ice melt area went from 40 percent of the ice sheet to 97 percent in four days, according to NASA. Until now, the most extensive melt seen by satellites in the past three decades was about 55 percent.

Wagner said researchers don't know how much of Greenland's ice melted, but it seems to be freezing again.

"When we see melt in places that we haven't seen before, at least in a long period of time, it makes you sit up and ask what's happening?" NASA chief scientist Waleed Abdalati said. It's a big signal, the meaning of which we're going to sort out for years to come."

About the same time, a giant iceberg broke off from the Petermann Glacier in northern Greenland. And the National Snow and Ice Data Center on Tuesday announced that the area filled with Arctic sea ice continues near a record low.

Wagner and other scientists said because this Greenland-wide melting has happened before they can't yet determine if this is a natural rare event or one triggered by man-made global warming. But they do know that the edges of Greenland's ice sheets have already been thinning because of climate change.

Summer in Greenland has been freakishly warm so far. That's because of frequent high pressure systems that have parked over the island, bringing warm clear weather that melts ice and snow, explained University of Georgia climatologist Thomas Mote.

He and others say it's similar to the high pressure systems that have parked over the American Midwest bringing record-breaking warmth and drought.

Ohio State University ice scientist Jason Box, who returned Tuesday from a three-week visit, said he ditched his cold weather gear for the cotton pants that he normally dons in Nevada.

"It was sunny and warm and all the locals were talking about how sunny it was," Box said after getting off a plane. "Beyond T-shirt weather."

___

Online:

NASA: http://www.nasa.gov/topics/earth/features/greenland-melt.html

___

Seth Borenstein can be followed at http://twitter.com/borenbears

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/3d281c11a96b4ad082fe88aa0db04305/Article_2012-07-24-Greenland%20Melt/id-eb4a54ec6c554b98922644bdbe7669bc

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Great Things About Social Bookmarking | Most Profitable Work by ...

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On this page we?re going to discuss what social bookmarking is and why businesses will incorporate this into their work from internet marketing plan. Firstly we?ll quickly go over what it?s, and we will speak about the rewards it could possibly give to companies. After studying this information, you?re then highly proposed to implement this course in promoting the trends in internet to your website.

?What exactly is social bookmarking and how come?it?is?essential?

?Social bookmarking providers guide people to gather and talk about their most favorite work from internet?web sites on the internet. This really is just like the ?My Faves? functionality, which can save your favourite web sites on your personal computer. The real key distinction is that your chosen favourite trends in internet?web sites will probably be stored on-line, rather than being stored in your pc.

Due to this services, users aren?t required to provide his or her personal computer out together with them or perhaps be frightened of getting rid of those internet sites whenever their pc has difficulty. Those web sites are kept on-line and could be seen once they logon on the social?bookmarking?internet site.

??Here are few great things about bookmarking web sites freely by some users:

?It gives info of a web site to others, such as exactly what the web site is all about and just what they think of ? ?it. Additionally, it consists of details about the other web sites can be like that one. If somebody would like conscious what sort of web sites they ought to visit when they would like to uncover specific details, a social ?bookmarking website has to be great place to start.

An additional benefit is that this permits people to talk about their most favorite web sites. Quite simply, they are able to share their most favorite web sites using their buddies, loved ones, or any other persons with similar interests and hobbies as them. There are sometimes whenever you can?t come across reliable information from the search engines. In cases like this you can look on web sites and find out who may have the details you would like.

?Lastly, social bookmarking websites can help to save individuals time and effort for acquiring, setting up and spreading web sites. From the advertising viewpoint, bookmarking your site is also a fairly easy and absolutely free way to get website traffic.

?Some Great Benefits Of Social?Bookmarking, From the Advertising Viewpoint

?The instant benefit from bookmarking your site is that you?ve a?web link?directing to your web page. Several of the social?bookmarking?internet sites have extremely high authority, meaning that web sites are reliable by many people. A web link from web sites is extremely impressive as a way to have a better ranking.

?One more clear advantage is to get website traffic. It?s extremely true for very well recognized?bookmarking?sites. Occasionally somebody bookmarks a web site, many people all of a sudden upturn to this website and so that website can?t manage this sort of massive amount of work from internet website traffic. Supplied that you?ve great and fascinating information and facts, it isn?t difficult to have instantaneous website traffic.

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Source: http://www.amazingbusinessonline.com/what-would-bethe-great-things-about-social-bookmarking/?utm_source=rss&utm_medium=rss&utm_campaign=what-would-bethe-great-things-about-social-bookmarking

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UCSF/SFGH researchers call for change in new FDA recommendation on HIV and TB drug doses

[ Back to EurekAlert! ] Public release date: 23-Jul-2012
[ | E-mail | Share Share ]

Contact: Jason Socrates Bardi
jason.bardi@ucsf.edu
415-502-6397
University of California - San Francisco

In January, 2012, the U.S. Food and Drug Administration (FDA) issued new guidelines on dosing of an HIV medication used to treat people infected with both HIV and tuberculosis (TB) because of a potential interaction between two of the main drugs used to treat each disease.

The drug rifampin, used for treating TB, can lower levels of the HIV medicine efavirenz, so the FDA recommended that patients who weigh more than 50 kg (110 pounds) and who are taking both medications should get 30 percent larger doses of efavirenz (an increase from 600 mg to 800 mg).

Now, a new analysis by conducted by researchers with the Adult AIDS Clinical Trials Group (ACTG) at the University of California, San Francisco (UCSF) and the San Francisco General Hospital and Trauma Center (SFGH) suggests this recommended dose adjustment may not be necessary, particularly in non-Caucasian populations.

As described in a talk at the XIX International AIDS Conference in Washington, D.C. on Monday, July 23, 2012, the new FDA guidelines were based on several small studies in European TB patients and one in healthy volunteers, indicating a decrease in efavirenz levels with rifampin. The guidelines were also informed by a mathematical model, which showed that increasing efavirenz to 800 mg when given with rifampin would increase levels to those seen on the regular dose of 600 mg.

These data may not apply to patients in African and Asian populations because of genetic differences that lead to higher efavirenz levelsor even in the United States, where more than half the people with TB and HIV co-infections are African American or Asian American.

"To make the recommendation across the board that all patients who weigh more than 50 kg should increase the dose of efavirenz is not supported by our research. Doing so may lead to more drug toxicity without improving the effectiveness of efavirenz in TB patients," said Annie Luetkemeyer, MD, an assistant professor of medicine at UCSF and an ACTG researcher at SFGH.

How the Two Drugs Interact

TB and HIV co-infections, while relatively rare in the United States, form a particularly devastating one-two punch in many parts of the world. Having HIV makes you twice at least twice as likely to develop tuberculosis, and TB is now the number one killer of people with HIV worldwide.

The problem is particularly pronounced in sub-Saharan Africa, where, according to the World Health Organization, about 60 percent of the people in the world with HIV/AIDS live and where a third of the 22 countries with the highest levels of TB are located.

Clinical evidence strongly suggests that people who have HIV and TB should be treated simultaneously for both diseases. Waiting to treat HIV until after TB treatment doubles the likelihood of death, and starting HIV treatment early in the course of TB reduces the risk of death and new AIDS complications in patients with advanced AIDS. Even waiting six weeks to start HIV treatment can increase this risk, said Luetkemeyer.

But rifampin and efavirenz, two of the front line drugs used to treat both diseases, interact through a liver enzyme in the human body known as cytochrome P450, which generally breaks down and metabolizes most drugs. When someone takes the anti-TB drug rifampin, it increases levels of these P450 enzymes, and they, in turn, break down the HIV drug efavirenz.

The FDA issued its new guidance specifically to address the concern that adults on both drugs who weigh more than 50 kg would run the risk of not having enough efavirenz, and they recommended that people simply take 30 percent larger doses of the anti-HIV drug (substituting 800 mg of efavirenz for the normal 600 mg dose).

However, the metabolic effect observed in the studies that the FDA looked at is also influenced by genetics, and people in African and Asian populations may be slower metabolizers than people in the predominantly white populations involved in the trials upon which the FDA based its recommendation.

In recent years, Luetkemeyer and her colleagues have collected clinical data specifically looking at how best to co-administer drugs for HIV with drugs for other infections through a large, randomized, multicenter ACTG clinical trial called STRIDE.

The main goal of the STRIDE study was to evaluated optimal timing of HIV treatment initiation in patients starting TB treatment with advance AIDS. The study was also able to look at how giving efavirenz and rifampin together impacted efavirenz levels and the effectiveness of the HIV treatment regimen and to see if weight made a difference in efavirenz levels or effectiveness.

What the STRIDE data showed in technical terms was that the effectiveness of the HIV drug efavirenz did not decrease as a result of its interaction with rifampin in patients weighing more than 50 kg compared to those weighing less than 50 kg. In addition, patients weighing more than 50 kg did not have more subtherapeutic efavirenz levels than those weighing less than 50 kg. In fact, in black patients efavirenz levels actually were higher while taking efavirenz compared to efavirenz levels once the rifampin was stopped.

In other words, said Luetkemeyer, increasing the doses of efavirenz may increase its side effects without making it more effective. The drugs are also expensive, and when prescribing more than is necessary across an entire population may strain budgets that already are stretched thin.

The STRIDE data reinforce data from other researchers that have shown efavirenz levels increase in many non-white patients on rifampin and that a standard dose of efavirenz has been as effective in TB patients on rifampin as in HIV patients without TB. Three quarters of the STRIDE study participants were black, however, so this study cannot address whether the dose adjustment is advisable in Caucasian patients.

While the FDA does not have the authority to regulate health systems, companies and products in other countries, it nevertheless has a powerful worldwide influence on health care because many poor countries have no similar government agencies to review available scientific data and issue guidance to doctors.

###

The talk, "Relationship between weight, efavirenz (EFV) concentrations and virologic suppression in HIV+ patients on rifampin (RIF)-based TB treatment in the ACTG 5221 STRIDE study" by AF Luetkemeyer, S. Rosenkranz, D. Lu, P.S. Lizak, P. Ive, S. Swindells, C. Benson, B. Grinzstejn, I. Sanne, D.V. Havlir, F. Aweeka and the Adult AIDS Clinical Trials Group A5221 Team will be at 4:30 p.m. ET on Monday, July 23, 2012 in Session Room 7.


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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


[ Back to EurekAlert! ] Public release date: 23-Jul-2012
[ | E-mail | Share Share ]

Contact: Jason Socrates Bardi
jason.bardi@ucsf.edu
415-502-6397
University of California - San Francisco

In January, 2012, the U.S. Food and Drug Administration (FDA) issued new guidelines on dosing of an HIV medication used to treat people infected with both HIV and tuberculosis (TB) because of a potential interaction between two of the main drugs used to treat each disease.

The drug rifampin, used for treating TB, can lower levels of the HIV medicine efavirenz, so the FDA recommended that patients who weigh more than 50 kg (110 pounds) and who are taking both medications should get 30 percent larger doses of efavirenz (an increase from 600 mg to 800 mg).

Now, a new analysis by conducted by researchers with the Adult AIDS Clinical Trials Group (ACTG) at the University of California, San Francisco (UCSF) and the San Francisco General Hospital and Trauma Center (SFGH) suggests this recommended dose adjustment may not be necessary, particularly in non-Caucasian populations.

As described in a talk at the XIX International AIDS Conference in Washington, D.C. on Monday, July 23, 2012, the new FDA guidelines were based on several small studies in European TB patients and one in healthy volunteers, indicating a decrease in efavirenz levels with rifampin. The guidelines were also informed by a mathematical model, which showed that increasing efavirenz to 800 mg when given with rifampin would increase levels to those seen on the regular dose of 600 mg.

These data may not apply to patients in African and Asian populations because of genetic differences that lead to higher efavirenz levelsor even in the United States, where more than half the people with TB and HIV co-infections are African American or Asian American.

"To make the recommendation across the board that all patients who weigh more than 50 kg should increase the dose of efavirenz is not supported by our research. Doing so may lead to more drug toxicity without improving the effectiveness of efavirenz in TB patients," said Annie Luetkemeyer, MD, an assistant professor of medicine at UCSF and an ACTG researcher at SFGH.

How the Two Drugs Interact

TB and HIV co-infections, while relatively rare in the United States, form a particularly devastating one-two punch in many parts of the world. Having HIV makes you twice at least twice as likely to develop tuberculosis, and TB is now the number one killer of people with HIV worldwide.

The problem is particularly pronounced in sub-Saharan Africa, where, according to the World Health Organization, about 60 percent of the people in the world with HIV/AIDS live and where a third of the 22 countries with the highest levels of TB are located.

Clinical evidence strongly suggests that people who have HIV and TB should be treated simultaneously for both diseases. Waiting to treat HIV until after TB treatment doubles the likelihood of death, and starting HIV treatment early in the course of TB reduces the risk of death and new AIDS complications in patients with advanced AIDS. Even waiting six weeks to start HIV treatment can increase this risk, said Luetkemeyer.

But rifampin and efavirenz, two of the front line drugs used to treat both diseases, interact through a liver enzyme in the human body known as cytochrome P450, which generally breaks down and metabolizes most drugs. When someone takes the anti-TB drug rifampin, it increases levels of these P450 enzymes, and they, in turn, break down the HIV drug efavirenz.

The FDA issued its new guidance specifically to address the concern that adults on both drugs who weigh more than 50 kg would run the risk of not having enough efavirenz, and they recommended that people simply take 30 percent larger doses of the anti-HIV drug (substituting 800 mg of efavirenz for the normal 600 mg dose).

However, the metabolic effect observed in the studies that the FDA looked at is also influenced by genetics, and people in African and Asian populations may be slower metabolizers than people in the predominantly white populations involved in the trials upon which the FDA based its recommendation.

In recent years, Luetkemeyer and her colleagues have collected clinical data specifically looking at how best to co-administer drugs for HIV with drugs for other infections through a large, randomized, multicenter ACTG clinical trial called STRIDE.

The main goal of the STRIDE study was to evaluated optimal timing of HIV treatment initiation in patients starting TB treatment with advance AIDS. The study was also able to look at how giving efavirenz and rifampin together impacted efavirenz levels and the effectiveness of the HIV treatment regimen and to see if weight made a difference in efavirenz levels or effectiveness.

What the STRIDE data showed in technical terms was that the effectiveness of the HIV drug efavirenz did not decrease as a result of its interaction with rifampin in patients weighing more than 50 kg compared to those weighing less than 50 kg. In addition, patients weighing more than 50 kg did not have more subtherapeutic efavirenz levels than those weighing less than 50 kg. In fact, in black patients efavirenz levels actually were higher while taking efavirenz compared to efavirenz levels once the rifampin was stopped.

In other words, said Luetkemeyer, increasing the doses of efavirenz may increase its side effects without making it more effective. The drugs are also expensive, and when prescribing more than is necessary across an entire population may strain budgets that already are stretched thin.

The STRIDE data reinforce data from other researchers that have shown efavirenz levels increase in many non-white patients on rifampin and that a standard dose of efavirenz has been as effective in TB patients on rifampin as in HIV patients without TB. Three quarters of the STRIDE study participants were black, however, so this study cannot address whether the dose adjustment is advisable in Caucasian patients.

While the FDA does not have the authority to regulate health systems, companies and products in other countries, it nevertheless has a powerful worldwide influence on health care because many poor countries have no similar government agencies to review available scientific data and issue guidance to doctors.

###

The talk, "Relationship between weight, efavirenz (EFV) concentrations and virologic suppression in HIV+ patients on rifampin (RIF)-based TB treatment in the ACTG 5221 STRIDE study" by AF Luetkemeyer, S. Rosenkranz, D. Lu, P.S. Lizak, P. Ive, S. Swindells, C. Benson, B. Grinzstejn, I. Sanne, D.V. Havlir, F. Aweeka and the Adult AIDS Clinical Trials Group A5221 Team will be at 4:30 p.m. ET on Monday, July 23, 2012 in Session Room 7.


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Source: http://www.eurekalert.org/pub_releases/2012-07/uoc--urc071712.php

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Al-Qaida leader: Expect more attacks in US?

By Jonathan Dienst, NBCNewYork.com

An al-Qaida leader in Iraq has threatened to soon carry out an attack inside "the heart" of the U.S.

Abu Bakr al-Baghdadi released an audio recording boasting that operatives from his al-Qaida affiliate are in the midst of planning a major terror operation.

"Soon you will witness them in the heart of your homeland, as our war with you has just begun, and so await them," al-Baghdadi said.


Federal and local security officials told NBC New York there are no new specific threats inside the U.S. The officials said that overseas terror leaders often make unsubstantiated claims and threats about targeting American interests.?

This latest terror threat message did not specify where or when such a plot might take place. New York, which officials say has faced more than a dozen unsuccessful terror plots since 9/11, appears not to be a target.

"There is no specific or credible threat to New York at this time," said FBI New York spokesman J. Peter Donald.

Officials have said the 2009 Zazi subway terror plot and the 2010 Times Square car bomb attempt were the most serious threats to date against the city. Both of those plots were planned with the help of al-Qaida operatives based in Pakistan.?

Al-Baghdadi ? which is believed to be a pseudonym -- became head of al-Qaida in Iraq in 2010.?

The al-Qaida affiliate in Yemen has also targeted U.S. airliners using explosives hidden in underwear. That group has also plotted to bomb cargo planes using explosives hidden in printer cartridges.

In 2005, al-Qaida in Iraq had been linked to a "baby stroller" bomb threat targeting New York subways. But after an investigation, security officials determined the alleged plot to smuggle bombs onto trains hidden in baby strollers was based on unsubstantiated information from intelligence sources overseas.

In addition to threats inside the U.S., al-Baghdadi boasted that the terror group would soon carry out more attacks and assassinations inside Iraq.

As for the U.S., he said "The leader of the infidels and protector of the Cross, I say to her: Your war on the Muslims is a failure, and soon enough Allah-willing you will collapse and accept defeat."

He went on to claim terror operatives were already en route to the US. "The Mujahideen have departed to pursue your fleeing army, and they have sworn to make you face more severe punishments than those dealt to you by Osama (bin Laden)."

NBC terrorism analyst Evan Kohlmann translated al-Baghdadi's comments.

Source: http://usnews.msnbc.msn.com/_news/2012/07/23/12909634-al-qaida-leader-threatens-to-carry-out-more-attacks-on-us-soil?lite

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