Search

Objective To investigate the impact of introducing a rapid test as the first-line diagnostic test for drug-sensitive tuberculosis in Cape Town, South Africa. Methods Xpert[R] MTB/RIF (Xpert[R]), an automated polymerase-chain-reaction-based assay, was rolled out between 2011 and 2013. Data were available on 102007 adults treated for pulmonary tuberculosis between 2010 and 2014. Tuberculosis notification rates per 100000 population were calculated for each calendar year and for each year relative to the test roll-out locally, overall and by bacteriological confirmation. Empirical treatment was defined as treatment given without bacteriological confirmation by Xpert[R], sputum smear microscopy or sputum culture. Findings Between 2010 and 2014, the proportion of human immunodeficiency virus (HlV)-negative patients treated empirically for tuberculosis declined from 23% (2445/10643) to 11% (1149/10089); in HIV-positive patients, it declined from 42% (4229/9985) to 27% (2364/8823). The overall tuberculosis notification rate decreased by 12% and 19% among HIV-negative and HIV-positive patients, respectively; the rate of bacteriologically confirmed cases increased by 1% and 3%, respectively; and the rate of empirical treatment decreased by 56% and 49%, respectively. These changes occurred gradually following the test's introduction and stabilized after 3 years. Conclusion Roll-out of the rapid test in a setting with a high prevalence of pulmonary tuberculosis and HIV infection was associated with a halving of empirical treatment that occurred gradually after the test's introduction, possibly reflecting the time needed for full implementation. More than a quarter of HIV-positive patients with tuberculosis were still treated empirically, highlighting the diagnostic challenge in these patients. Objectif Analyser l'impact de iIntroduction d'un test rapide comme test initial de diagnostic de la tuberculose pharmacosensible au Cap, en Afrique du Sud. Methodes Le test Xpert[R] MTB/RIF (Xpert[R]), un test automatise qui repose sur le principe de i'amplification en chaine par polymerase, a ete deploye entre 2011 et 2013. Des donnees etaient disponibles au sujet de 102 007 adultes traites contre la tuberculose pulmonaire entre 2010 et 2014. Le taux de signalement de cas de tuberculose pour 100 000 habitants a ete calcule pour chaque .annee civile et pour chaque annee de depioiement du test a l'echelon local, global et avec confirmation bacteriologique. Nous avons defini les traitements empiriques comme les traitements donnes sans confirmation bacteriologique par le test Xpert[R], examen microscopique de frottis d'expectorations ou culture d'expectorations. Resultats Entre 2010 et 2014, la proportion de patients seronegatifs au virus de l'Immunodeficience humaine (VIH) traites empiriquement contre la tuberculose est passee de 23% (2445/10 643) a 11% (1149/10089); chez les patients seropositlfs, elle est passee de 42% (4229/9985) a 27% (2364/8823). Le taux global de signalement des cas de tuberculose a balsse respectivement de 12% et de 19% chez les patients seronegatifs et seropositlfs au VIH; le taux confirme bacterlologiquement a augmente respectivement de 1 % et de 3%; et le taux d'administration de traitements empiriques a baisse respectivement de 56% et de 49%. Ces changements sont intervenus progressivement apres l'introduction du test et se sont stablllses au bout de 3 ans. Conclusion Le depioiement du test rapide dans une zone ayant une forte prevalence de tuberculose pulmonaire et de VIH a ete associe a une reduction de moitie des traitements empiriques, qui s'est faite progressivement apres l'introduction du test--ce qui reflete peut-etre le temps necessaire a sa mise en oeuvre integrale. Plus d'un quart des patients seropositlfs au VIH atteints de tuberculose etaient encore traites empiriquement, ce qui montre les enjeux du diagnostic pour ces patients. Objetivo Investigarei impacto de la introduccion de una prueba rapida como la prueba de diagnostico de primera linea para la tuberculosis sensible a los medicamentos en Ciudad del Cabo, Sudafrica. Metodos Entre 2011 y 2013 se implemento Xpert[R] MTB/RIF (Xpert[R]), una prueba automatizada basada en una reaccion en cadena de polimerasa. Se dispuso informacion sobre 102 007 adultos tratados de tuberculosis pulmonar entre 2010 y 2014. Se calcularon las tasas de notificacion de tuberculosis por cada 100000 habitantes por ano civil y por ano en relacion con la puesta en marcha de la prueba a nivel local, general y por confirmacion bacteriologica. El tratamiento empirico se definio como un tratamiento proporcionado sin confirmacion bacteriologica por parte de Xpert[R], microscopia de frotis de esputo o cultivo de esputo. Resultados Entre 2010 y 2014, el porcentaje de pacientes negativos en el virus de la inmunodeficiencia humana (VIH) tratados de forma empirica de tuberculosis cayo de un 23% (2445/10643) a un 11% (1149/10089); en pacientes positivos en VIH, cayo de un 42% (4229/9985) a un 27% (2364/8823). En general, la tasa de notificacion de tuberculosis cayo un 12% y un 19% entre pacientes con VIH negativo y positivo, respectivamente; la tasa de casos confirmados a nivel bacteriologico aumento un 1% y un 3%, respectivamente; y la tasa de tratamiento empirico se redujo un 56% y un 49%, respectivamente. Estos cambios se produjeron de forma gradual tras la implementacion de la prueba y se estabilizaron pasados 3 anos. Conclusion La puesta en marcha de la prueba rapida en un lugar con una alta prevalencia de tuberculosis pulmonar e infeccion por VIH se asocio con una reduccion a la mitad del tratamiento empirico que se aplico de forma gradual tras la introduccion de la prueba, reflejando posiblemente el momento necesario para la completa implementacion. Aun asi, mas de un cuarto de los pacientes positivos en VIH y con tuberculosis se sometieron a un tratamiento empirico, lo que destaca el problema del diagnostico en estos pacientes., Introduction Sputum smear microscopy is traditionally the first-line diagnostic test for tuberculosis in countries without routine access to the gold standard: sputum culture. This approach is limited by low sensitivity, [...]

Four experiments were carried out to investigate an early- versus late-selection explanation for the attentional blink (AB). In both Experiments 1 and 2, 3 groups of participants were required to identify a noun (Experiment 1) or a name (Experiment 2) target (experimental conditions) and then to identify the presence or absence of a 2nd target (probe), which was their own name, another name, or a specified noun from among a noun distractor stream (Experiment 1) or a name distractor stream (Experiment 2). The conclusions drawn are that individuals do not experience an AB for their own names but do for either other names or nouns. In Experiments 3 and 4, either the participant's own name or another name was presented, as the target and as the item that immediately followed the target, respectively. An AB effect was revealed in both experimental conditions. The results of these experiments are interpreted as support for a late-selection interference account of the AB.

Introduction: Although antiretroviral therapy (ART) reduces individual tuberculosis (TB) risk by two‐thirds, the population‐level impact remains uncertain. Cape Town reports high TB notification rates associated with endemic HIV. We examined population trends in TB notification rates during a 10‐year period of expanding ART. Methods: Annual Cape Town TB notifications were used as numerators and mid‐year Cape Town populations as denominators. HIV‐stratified population was calculated using overall HIV prevalence estimates from the Actuarial Society of South Africa AIDS and Demographic model. ART provision numbers from Western Cape government reports were used to calculate overall ART coverage. We calculated rates per 100,000 population over time, overall and stratified by HIV status. Rates per 100,000 total population were also calculated by ART use at treatment initiation. Absolute numbers of notifications were compared by age and sub‐district. Changes over time were described related to ART provision in the city as a whole (ART coverage) and by sub‐district (numbers on ART). Results: From 2003 to 2013, Cape Town's population grew from 3.1 to 3.7 million inhabitants, and estimated HIV prevalence increased from 3.6 to 5.2%. ART coverage increased from 0 to 63% in 2013. TB notification rates declined by 16% (95% confidence interval (CI), 14–17%) from a 2008 peak (851/100,000) to a 2013 nadir (713/100,000). Decreases were higher among the HIV‐positive (21% (95% CI, 19–23%)) than the HIV‐negative (9% (95% CI, 7–11%)) population. The number of HIV‐positive TB notifications decreased mainly among 0‐ to 4‐ and 20‐ to 34‐year‐olds. Total population rates on ART at TB treatment initiation increased over time but levelled off in 2013. Overall median CD4 counts increased from 146 cells/µl (interquartile range (IQR), 66, 264) to 178 cells/µl (IQR 75, 330; p Conclusions: HIV‐positive TB notification rates declined during a period of rapid scale‐up of ART. Nevertheless, both HIV‐positive and HIV‐negative TB notification rates remained very high. Decreases among HIV positives were likely blunted by TB remaining a major entry to the ART programme and occurring after delayed ART initiation., Introduction Antiretroviral therapy (ART) reduces the individual tuberculosis (TB) risk by two‐thirds [1]. This reduction is time‐ and CD4+ T‐cell (CD4) count‐dependent, however [2]. The TB risk is highest at [...]

Background Retreatment tuberculosis (TB) disease is common in high-prevalence settings. The risk of repeated episodes of recurrent TB is unknown. We calculated the rate of recurrent TB per subsequent episode by matching individual treatment episodes over a period of 13 years. Methods All recorded TB episodes in Cape Town between 2003 and 2016 were matched by probabilistic linkage of personal identifiers. Among individuals with a first episode notified in Cape Town and who completed their prior treatment successfully we estimated the recurrence rate stratified by subsequent episode and HIV status. We adjusted person-time to background mortality by age, sex, and HIV status. Results A total of 292 915 TB episodes among 263 848 individuals were included. The rate of recurrent TB was 16.4 per 1000 person-years (95% CI, 16.2–16.6), and increased per subsequent episode (8.4-fold increase, from 14.6 to 122.7 per 1000 from episode 2 to 6, respectively). These increases were similar stratified by HIV status. Rates among HIV positives were higher than among HIV negatives for episodes 2 and 3 (2- and 1.5-fold higher, respectively), and the same thereafter. Conclusions TB recurrence rates were high and increased per subsequent episode, independent of HIV status. This suggests that HIV infection is insufficient to explain the high burden of recurrence; it is more likely due to a high annual risk of infection combined with an increased risk of infection or progression to disease associated with a previous TB episode. The very high recurrence rates would justify increased TB surveillance of patients with >1 episode. [ABSTRACT FROM AUTHOR]

Abstract Background In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved. In this research, set in public primary care services in Cape Town, South Africa, we set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service. Methods A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. They used a comprehensive health systems framework based on conditions for programme effectiveness and then identified and collected tracer indicators. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities) was done in February 2006. Results 16 clinics were reviewed and 635 records sampled. Client access to HIV/TB/STI programmes was limited in that 50% of facilities routinely deferred clients. Whilst the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care). Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols) and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility. Conclusions This use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions.

Objectives: To investigate the feasibility of ultrasound shear wave elastography (SWE) in assessing iliocostalis lumborum muscle changes after osteopathic manipulative treatment (OMT). Methods: Using a linear array ultrasound transducer (4–9 MHz), we prospectively measured the shear wave velocity (SWV) of bilateral iliocostalis lumborum muscles in 20 patients with low back somatic dysfunction and in 9 age‐matched healthy volunteers. The SWV was measured in muscle relaxation and contraction in all participants and immediately before and after OMT in patients. We developed a muscle SWV rate [SWVcontraction – SWVrelaxation)/SWVrelaxation] and an SWV improvement index [(SWVpre‐OMT – SWVpost‐OMT)/SWVpre‐OMT] for quantifying muscle contractibility and changes in muscle stiffness after OMT. Statistical analyses included an unpaired t test to analyze the difference in the muscle SWV between muscle relaxation and contraction and between somatic dysfunction and nonsomatic dysfunction in patients and healthy volunteers, a paired t test to examine the difference in the SWV and SWV rate before and after OMT, the intraclass correlation coefficient to test intraobserver and interobserver reliability, and Spearman rank correlation to analyze the correlation of changes in the SWV with manual osteopathic assessments. Results: The mean ages of the patients with low back somatic dysfunction and the healthy volunteers were 28 and 26 years, respectively. The muscle SWV significantly differed between somatic dysfunction and nonsomatic dysfunction in patients and healthy volunteers, between muscle relaxation and contraction, and before and after OMT (P <.001). The SWV improvement index moderately correlated with manual osteopathic assessments (r = 0.68). The interobserver and intraobserver reliability for performing SWE was good (intraclass correlation coefficient, >0.8). Conclusions: Our results suggest that SWE is feasible for quantifying the change in muscle stiffness and contractibility after OMT. [ABSTRACT FROM AUTHOR]

Setting: Primary health services in Cape Town, South Africa. Study Aim: To compare tuberculosis (TB) diagnostic yield in an existing smear/culture-based and a newly introduced Xpert® MTB/RIF-based algorithm. Methods: TB diagnostic yield (the proportion of presumptive TB cases with a laboratory diagnosis of TB) was assessed using a non-randomised stepped-wedge design as sites transitioned to the Xpert® based algorithm. We identified the full sequence of sputum tests recorded in the electronic laboratory database for presumptive TB cases from 60 primary health sites during seven one-month time-points, six months apart. Differences in TB yield and temporal trends were estimated using a binomial regression model. Results: TB yield was 20.9% (95% CI 19.9% to 22.0%) in the smear/culture-based algorithm compared to 17.9% (95%CI 16.4% to 19.5%) in the Xpert® based algorithm. There was a decline in TB yield over time with a mean risk difference of -0.9% (95% CI -1.2% to -0.6%) (p<0.001) per time-point. When estimates were adjusted for the temporal trend, TB yield was 19.1% (95% CI 17.6% to 20.5%) in the smear/culture-based algorithm compared to 19.3% (95% CI 17.7% to 20.9%) in the Xpert® based algorithm with a risk difference of 0.3% (95% CI -1.8% to 2.3%) (p = 0.796). Culture tests were undertaken for 35.5% of smear-negative compared to 17.9% of Xpert® negative low MDR-TB risk cases and for 82.6% of smear-negative compared to 40.5% of Xpert® negative high MDR-TB risk cases in respective algorithms. Conclusion: Introduction of an Xpert® based algorithm did not produce the expected increase in TB diagnostic yield. Studies are required to assess whether improving adherence to the Xpert® negative algorithm for HIV-infected individuals will increase yield. In light of the high cost of Xpert®, a review of its role as a screening test for all presumptive TB cases may be warranted. [ABSTRACT FROM AUTHOR]

The article discusses servant leadership philosophy of Mary Parker Follett. It mentions Follett born in 1868 in Quincy, Massachusetts, enrolled in Radcliffe College: the women s branch of Harvard University, and published her third book, "Creative Experience" focusing on process and interaction in 1924. It also mentions applicability of servant leadership characteristics in a for-profit setting, i.e., in a proprietary institution of higher education.

Studies the orthographic similarity effects in the encoding and reconstruction of rapidly presented word lists. Support to the reconstructive account by a series of experiments that show a retroactive effect in which report of nonword is enhanced by similarity to a word; Ability of a nonword to interfere or enhance the report of a word.

Presents study to investigate an early- versus late-selection explanation for the attentional blink (AB). Experiments; Subjects; Methods; Results showing support for a late-selection interference account of the AB.

Context: Diagnosis of somatic dysfunction is based on subjective palpatory osteopathic assessments. This subjectivity has posed a challenge for researchers in studying osteopathic medicine. The development and use of radiological imaging techniques to objectively confirm or quantify muscle tissue stiffness associated with somatic dysfunction could be of benefit in osteopathic clinical practice, training, and further research., Objectives: To investigate the feasibility of ultrasound shear wave elastography (SWE) to quantify muscle tissue stiffness in somatic dysfunction before and after osteopathic manipulative treatment (OMT)., Methods: In this prospective study, we assessed lumbar spine somatic dysfunction in 20 adult patients before and after a single OMT session using standard osteopathic palpatory assessments by osteopathic physician faculty members in the Department of Osteopathic Principle and Practice at Rocky Vista University College of Osteopathic Medicine (Utah campus). Shear wave velocity (SWV, m/s) was measured in lumbar paraspinal muscle tissue using a commercial ultrasonography scanner on all participants immediately before and after OMT. In this study, OMT techniques targeted the iliocostalis lumborum and included the articulatory technique, balanced ligamentous tension, facilitated positional release, high-velocity, low-amplitude technique, muscle energy, myofascial release, and the Still technique at the discretion of the osteopathic physician. The difference in SWV between muscle tissues with and without dysfunction, and differences in SWV of dysfunctional tissue before and after OMT were examined using unpaired and paired t tests, as appropriate. The correlation between SWV measurements and osteopathic assessments was examined by the Spearman rank correlation. Intra- and interobserver reliability was analyzed using intraclass correlation coefficient., Results: The difference in SWV between muscle tissues with and without somatic dysfunction was significant before OMT (mean [SD], 1.93 [0.44] vs 1.69 [0.19]; P=.03) and was not significant after OMT (mean [SD], 1.69 [0.19] vs 1.53 [0.31]; P=.05). The difference in SWV in the same tissue with somatic dysfunction before and after OMT was significant (mean [SD], 1.93 [0.44] vs 1.52 [0.3]; P<.001). The SWV value highly correlated with manual osteopathic assessments (r=0.72). Intra- and interobserver reliability for performing SWE in somatic dysfunction was good (intraclass correlation coefficient >0.80)., Conclusions: The results of this study show that ultrasound SWE can objectively assess muscle tissue stiffness for diagnosis of somatic dysfunctions and for muscle tissue stiffness changes after OMT.