Abstract-The ubiquity of location enabled devices has resulted in a wide proliferation of location based applications and services. To handle the growing scale, database management systems driving such location based services (LBS) must cope with high insert rates for location updates of millions of devices, while supporting efficient real-time analysis on latest location. Traditional DBMSs, equipped with multi-dimensional index structures, can efficiently handle spatio-temporal data. However, popular opensource relational database systems are overwhelmed by the high insertion rates, real-time querying requirements, and terabytes of data that these systems must handle. On the other hand, Key-value stores can effectively support large scale operation, but do not natively support multi-attribute accesses needed to support the rich querying functionality essential for the LBSs. We present MD-HBase, a scalable data management system for LBSs that bridges this gap between scale and functionality. Our approach leverages a multi-dimensional index structure layered over a Key-value store. The underlying Key-value store allows the system to sustain high insert throughput and large data volumes, while ensuring fault-tolerance, and high availability. On the other hand, the index layer allows efficient multi-dimensional query processing. We present the design of MD-HBase that builds two standard index structures-the K-d tree and the Quad tree-over a range partitioned Key-value store. Our prototype implementation using HBase, a standard open-source Key-value store, can handle hundreds of thousands of inserts per second using a modest 16 node cluster, while efficiently processing multidimensional range queries and nearest neighbor queries in realtime with response times as low as hundreds of milliseconds.

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BackgroundCandidia esophagitis (CE) is an AIDS-defining condition, usually occurring in individuals with low CD4 counts of <200 cells/µL. Endoscopy is a valuable definitive diagnostic method for CE but may not be indicated for asymptomatic patients or for those with high CD4 counts or without oral candidiasis. This study assessed such patients to clarify the factors associated with CE and its severity on endoscopy in the highly active antiretroviral therapy (HAART) era.Methodology/ Principal FindingsA total of 733 HIV-infected patients who underwent upper gastrointestinal (GI) endoscopy were analyzed. Sexual behavior, CD4+ count, HIV-RNA viral load (VL), history of HAART, GI symptoms, GI diseases, and oral candidiasis were assessed. Endoscopic severity of CE was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of the 733 subjects, 62 (8.46%) were diagnosed with CE (mild, n = 33; severe, n = 29). Of them, 56.5% (35/62) had no GI symptoms, 30.6% (19/62) had CD4 + ≥200 cells/μL, and 55.3% (21/38) had no oral candidiasis. Univariate analysis found lower CD4+ counts, higher HIV VL, and no history of HAART to be significantly associated with CE. With lower CD4+ counts and higher HIV VL, CE occurrence increased significantly (P<0.01 for trend in odds). Multivariate analysis showed low CD4+ counts and high HIV VL to be independently associated with CE. Of the severe CE patients, 55.2% (16/29) had no GI symptoms and 44.4% (8/18) had no oral candidiasis. Median CD4+ counts in severe cases were significantly lower than in mild cases (27 vs. 80; P = 0.04).ConclusionsLow CD4+ counts and high HIV VL were found to be factors associated with CE, and advanced immunosuppression was associated with the development of severity. Endoscopy is useful as it can detect CE, even severe CE, in patients without GI symptoms, those with high CD4 counts, and those without oral candidiasis.

Amebic colitis is increasing among younger men who have syphilis or HIV.

Endoscopic diagnosis of amebic colitis can be difficult because its appearance may mimic other forms of colonic disease. The aim of this study was to identify predictive endoscopic findings for amebic colitis. Patients with suspected amebic colitis based on distinctive endoscopic findings such as aphthae or erosions, ulcers, exudates, or a bump, were included in the study. A total of 157 patients were selected, 50 of whom had amebic colitis. The sensitivity and specificity of endoscopic findings that were significantly associated with amebic colitis were: cecal lesions (80% and 54%), multiple number of lesions (96% and 29%), presence of aphthae or erosions (84% and 37%), and presence of exudate (88% and 74%). Multivariate analysis revealed that the best combination of findings to predict amebic colitis was the presence of cecal lesions, multiple lesions, and exudates, which corresponded to an area under the receiver operating characteristic curve of 0.89 (95% confidence interval 0.82-0.95).