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This article argues that the indefinite detention and torture of prisoners at the Guantanamo Bay Detention Camp and the intentional destabilization of Palestinian civilian life in the Israeli occupied Palestinian territories are indicative of the emergence of a new postmodern form of power. Coining the term homo dolorosus – the man who is available to be made to suffer – this article seeks to understand this emergent politics of suffering through a historicized reading of Foucault's typology of power, informed by the work of Giorgio Agamben. It is argued that, just as discipline was the dark inverse of the modern utopian Enlightenment project of universal democratic inclusion, the politics of suffering is the dark inverse of the postmodern biopolitical project of security. Using the work of Mikkel Joronen, Jasbir Puar and Lauren Wilcox as signposts, this article argues that homo dolorosus is produced by power's encounter with a population that it perceives or represents as simultaneously risky and dependent. Moreover, it is suggested that homo dolorosus may be the manifestation of a project that aims to do away with freely-deciding subjectivity while keeping the human body alive. [ABSTRACT FROM AUTHOR]

Objectives/Background. Improving adherence to CPAP devices is crucial to reduce the long-term morbidity associated with OSA. SensAwake is a unique pressure relief technology that aims to promptly reduce the pressure upon sensing irregular respiration indicative of wakefulness. The purpose of this study was to compare adherence and sleep-quality outcomes in patients treated by CPAP with and without SensAwake technology. Methods. Participants with moderate-to-severe OSA were randomized to use CPAP devices with or without SensAwake (4 weeks) before crossing over. Results. Sixty-five patients completed both arms of the trial. There were no statistically significant differences in CPAP adherence with or without SensAwake over the study period (SensAwake ON 272.67±17.06 versus SensAwake OFF 289.09±15.24; p=0.180). SensAwake reported a significantly lower system leak, 90th percentile leak, and time spent with excessive (>60 L/min) leak. Subgroup analysis suggested a trend towards improved adherence in patients with moderate-to-severe insomnia when using SensAwake. Conclusions. Using SensAwake incurred benefit in terms of reduced leaks; however, SensAwake did not improve CPAP adherence or objective sleep quality. Further studies should investigate the accuracy of observed trends towards increased adherence using SensAwake among patients with OSA and insomnia. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) has emerged as a significant threat to global health security and threatens the achievements of modern medicine. Research and successful development of new antibiotics, especially those with novel mechanisms of action vital to combat resistance, has slowed dramatically since the 1980s. Surveillance for AMR is highly variable globally with significant limitations in many countries impeding the ability to fully characterize the problem. Global efforts to control tuberculosis, malaria and HIV are facing increasing difficulties from the emergence of resistance. Similarly, bacteria causing some of the most common infections in communities or in hospitals such as Escherichia coli and Klebsiella pneumoniae have shown high levels of resistance to third generation cephalosporins requiring treatment with expensive carbapenems as last-resort. Additionally, Streptococcus pneumoniae has shown reduced susceptibility to penicillin in many regions, exceeding 50% in some settings. The cost in lives from AMR over the next 40 years could go as high as 10 million per year with the cost to economic development as high as $3 trillion per year if current trends continue. In addition to ensuring appropriate use of antibiotics and development of novel classes with new or enhanced mechanisms of action, many plans for the global response call for new vaccines as integral to the fight against AMR. Vaccines and antibiotics should be used together to produce synergistic gains in public health, and ultimately, vaccines will extend the clinical utility of antibiotics. The decrease in cases of invasive pneumococcal disease and decrease in prescriptions for antibiotics in some settings resulting from the introduction of broad access to, and utilization of conjugate vaccines for Streptococcus pneumoniae exemplifies the synergy that can be achieved in the fight against AMR. [ABSTRACT FROM AUTHOR]

Consider a system which is subject to occasional failures over its lifetime. Under general stochastic assumptions concerning the occurrence of these failures, the duration of the repair times, and the length of the system's lifetime, the distribution of the total uptime the system accumulates over its lifetime may be determined. While the distribution is unfortunately complicated except in certain circumstances, it is possible to derive useful bounds based on the aging characteristics of the distributions of interfailure times, repair times, and system life. Bounds are developed for the cases where the system lifetime follows (1) a degenerate distribution (or constant mission duration), (2) an exponential distribution, and (3) a general distribution. These bounds may be interpreted as extensions of well-known bounds based on aging notions from renewal theory. Conditions are identified for when the bounds are sharp, and examples are used to show the computational tractability and usefulness of the results. [ABSTRACT FROM AUTHOR]

The authors encourage the use of digital health technologies to promote adherence to tuberculosis treatment. Topics discussed include the nonadherence risk posed by the duration and complexity of the multi-drug regimen adopted for the treatment of drug-sensitive tuberculosis, advantages of the 99DOTS mobile phone-based digital health technology for remote monitoring of medication intake, and the clinical monitoring potential of directly observed therapy by video recording services.

The article discusses the court case D'Amario v. Ford, wherein the court decided that the jury should be permitted to apportion fault to each entity that caused the plaintiff's injuries, in consistent with F.S. 768.81. It presents the public policy and economic considerations that demonstrate the immediate need for judicial and legislative action to eliminate D'Amario's adverse consequences from the tort law of Florida. It also analyzes the judicial legacy of the D'Amario decision.

Background: The paper illustrates the MST treatment model with three types of presenting problem in young people aged 14–15. Method: The MST model is described and then illustrated with detailed case material from a violent young person convicted of robbery, a young person with a history of serious self-harming behaviour and hospitalisation, and a young person persistently smoking cannabis. Results: All three cases improved after the MST intervention despite disparate presenting problems that included re-offending, the elimination of self-harming behaviour and a significant reduction in the use of cannabis. The three young people were re-integrated into the education system. Conclusion: This case series illustrates the potential uses of the MST model in CAMHS although RCT data are needed to replicate the effectiveness of MST in the British context. [ABSTRACT FROM AUTHOR]

Background. Multidrug-resistant (MDR) tuberculosis (TB) has emerged as a global epidemic, with ~425,000 new cases estimated to occur annually. The global human immunodeficiency virus (HIV) infection epidemic has caused explosive increases in TB incidence and may be contributing to increases in MDR-TB prevalence. Methods. We reviewed published studies and available surveillance data evaluating links between HIV infection and MDR-TB to quantify convergence of these 2 epidemics, evaluate the consequences, and determine essential steps to address these epidemics. Results. Institutional outbreaks of MDR-TB have primarily affected HIV-infected persons. Delayed diagnosis, inadequate initial treatment, and prolonged infectiousness led to extraordinary attack rates and case-fatality rates among HIV-infected persons. Whether this sequence occurs in communities is less clear. MDR-TB appears not to cause infection or disease more readily than drug-susceptible TB in HIV-infected persons. HIV infection may lead to malabsorption of anti-TB drugs and acquired rifamycin resistance. HIV-infected patients with MDR-TB have unacceptably high mortality; both antiretroviral and antimycobacterial treatment are necessary. Simultaneous treatment requires 6-10 different drugs. In HIV-prevalent countries, TB programs struggle with increased caseloads, which increase the risk of acquired MDR-TB. Surveillance data suggest that HIV infection and MDR-TB may converge in several countries. Conclusions. Institutional outbreaks, overwhelmed public health programs, and complex clinical management issues may contribute to the convergence of the MDR-TB and HIV infection epidemics. To forestall disastrous consequences, infection control, rapid case detection, effective treatment, and expanded program capacity are needed urgently. [ABSTRACT FROM AUTHOR]

This study examined the differences in the epistemological beliefs of college students across major fields of study. Beliefs in fixed ability, simple knowledge, quick learning, and certain knowledge were assessed for 290 students attending a large urban public university. Major fields of study were classified in domains of study according to the hard-soft and pure-applied dimensions of Biglan's well-known classification of academic fields. Additional analyses examined the effects of gender, age, year in college, and GPA. Results indicated that students majoring in pure fields were less likely than those in applied fields to hold naive beliefs in simple knowledge, quick learning, and certain knowledge, and students majoring in soft or pure fields were less likely than others to hold naive beliefs in certain knowledge. Gender, age, and GPA were also related to students' beliefs. The results of this study suggest that students' beliefs about the nature of knowledge and learning are related to the disciplinary contexts in which students select and experience their specialized coursework in college. [ABSTRACT FROM AUTHOR]

BSTRACT [ABSTRACT FROM AUTHOR]

A species complex in Spirogyra consists of the series of filament morphotoypes of various ploidal levels arising from an original morphotype within a clonal culture or in nature. A clonal culture of filaments identified as Spirogyra maxima (Hasall) Kützing produced several morphotypes, i.e. filament types of distinctly different widths and ploidal level. Banding patterns and satellites were visible on chromosomes stained at mitotic prophase and metaphase. The original culture of S. maxima contained filaments averaging 127 μm wide. Vegetative cells of the original culture contained six large chromosomes (>4 μm long), identifiable as three distinct pairs based on banding patterns and presence of satellites: (1) one pair of short chromosomes (ca. 5.0 μm); (2) one pair of long chromosomes (ca. 8.0 μm); and (3) a second pair of long chromosomes (ca. 9.0 μm) including a nucleolar organizing region and satellite. A larger morphotype averaging 175 μm in width contained 12 chromsomes, with two pairs of short chromosomes and four pairs of long chromosomes (satellites were usually indistinct). Aneuploid chromosome numbers ranging from 5 to 13 were observed in a few cells. Binucleate and trinucleate cells were also observed. A two-banded chromosome fragment was observed in a few cells with 6 chromosomes and a few cells with 12 chromosomes. The variety of morphotypes derived in this study could be identified as four different species of Spirogyra by conventional taxonomic criteria. The banding patterns and satellites on chromosomes suggest that three pairs of homologous chromosomes are present in filaments of the original clonal culture and that these filaments are themselves autopolyploid (diploid) descendants of an ancestral form with a base chromosome number of x = 3. [ABSTRACT FROM AUTHOR]

Examines the relationship of pulmonary fibrosis and lung cancer in the United States. Multiple cause of death mortality data; Variation in the degrees of severity of disease.

Presents certain ideas originating from computer science that might be beneficial in teaching and exposition of mathematics.

The nuclear cytology of 9 strains of Sirogonium is described. The interphase nucleus contains 1-3 nucleoli, a nucleolar-organizing track, and many (>100) chromocenters. During the division cycle the nucleoli are transformed into a nucleolar substance which becomes associated with the chromosome and is transported through mitosis on the chromosomes. All strains possess minute dot chromosomes varying in length at metaphase from 0.5 to 1.5 μ; satellite chromosomes are 2.5-3.5 μ long. The number of chromosomes varies from 48 ± 2 to 100 ± 2. No evidence of centromeric activity was observed. [ABSTRACT FROM AUTHOR]

Orel oblast, Russia, is the site of a WHO demonstration project for tuberculosis control. We used data acquired by the Center for Prevention of AIDS and Infectious Diseases to show that, in this region, the seroprevalence of HIV-1 infection has increased 33-fold in 4 years. The rapid spread of HIV-1 in Russia has serious implications for control of tuberculosis epidemics. Although the HIV-1 epidemic is at an early stage, aggressive prevention measures must be taken quickly to avoid the adverse effects of widespread HIV on tuberculosis control that have been seen in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Group-based parent training programmes are a common intervention for tackling conduct problems in young people. The objective of this study was to evaluate the impact of a parent training programme on young people presenting with conduct problems. 123 parents of young people aged 10 to 17 with conduct problems participated in the study. A one-group, pre-post design was adopted. Participants completed the Child Behaviour Check List (CBCL) at the beginning and end of the parenting programme. The degree of change was indexed by: a) Mean change; b) change from clinical to non-clinical status; and c) Reliable change. Logistic regression was used to identify predictors of reliable positive change in CBCL problems. Analyses from all three sources suggest that there was a significant reduction in CBCL internalising, externalising and total scores. Withdrawn score pre-treatment was the only independent predictor of reliable change in internalising and total scores: the higher the score pre-treatment, the greater the chances of reliable improvement in post-treatment scores. The study provides evidence in support of the therapeutic improvement achieved by some young people whose parents attended the group parent training programme. The programme had a significant impact on internalising as well as externalising problems. Further studies of the programme would benefit from being run as a randomised clinical trial. [ABSTRACT FROM AUTHOR]

Objective. To describe trends and highlight epidemiologic and clinical characteristics of childhood tuberculosis (TB) in the United States. Methods. All verified TB cases reported to the national TB surveillance system from 1993 to 2001 were included. A child was defined as a person younger than 15 years. Results. A total of 11 480 childhood TB cases were reported. Case rates (TB cases/100 000 population) in all children declined from 2.9 (n = 1663) in 1993 to 1.5 (n = 931) in 2001. Among children, those who were younger than 5 years had the highest rate. California, Texas, and New York accounted for 48% of all childhood TB cases. In 2001, TB case rates were higher for foreign-born (12.2) than US-born children (1.1). Hispanic and non-Hispanic black children accounted for nearly three quarters of all cases. Twenty-four percent of children with TB were foreign-born children, with the largest number originating from Mexico (39.8%), the Philippines (8.6%), and Vietnam (5.7%). Most children had evidence of pulmonary TB disease (78.9%). Among culture-positive cases without previous TB, drug resistance to at least isoniazid was 7.3% and to isoniazid and rifampin was 1.6%. In 1999, 82.9% of children received directly observed therapy for at least part of their treatment and 94.8% completed treatment. Conclusions. Although the overall TB case number among children is declining in the United States, certain groups of children (eg, younger children, racial and ethnic minorities, foreign-born) are at higher risk for TB. As the United States moves toward the elimination of TB, future efforts should endeavor to prevent all cases of childhood TB. [ABSTRACT FROM AUTHOR]

Pauson–Khand cyclization of the enamide 9 proceeds in trifluoroethanol to give cyclopentenone 10, which on hydrogenation gives 11, having the core ABC-rings of nakadomarin 1. [Copyright &y& Elsevier]

Objective: To assess the evolution of narcolepsy symptoms in first-, second, and third-degree relatives and to compare multiplex and simplex families.Methods: A total of 4045 family members and 362 narcoleptic individuals were entered in the study; with 3255 family members interviewed twice, five to seven years apart. A control group (n = 178) composed of spouses or housemates was also interviewed twice. Family members were divided according to their blood relationship with the probands and further divided into multiplex (ie, more than one narcolepsy cases) and simplex (only one narcolepsy case) families. Telephone interviews were conducted with the help of the Sleep-EVAL system; narcolepsy probands were evaluated and diagnosed by a Sleep Specialist in a Sleep Clinic Center.Results: A total of 1123 family members from 72 families were identified as members of multiplex families while the rest of the sample were a part of simplex families (n = 2132). Multiplex families had higher incidence and chronicity of hypersomnolence than the simplex family members and the control group. For cataplexy-like symptoms, only prevalence at the time of the first assessment distinguished multiplex (5.5%) and simplex (2.9%) families. Prevalence of sleep paralysis was higher among the first- and second-degree relatives coming from multiplex families, while incidence was the highest among second- and third-degree relatives. Hypnagogic hallucinations had similar prevalence between multiplex and simplex families but the incidence and chronicity were significantly higher among multiplex families. For each symptom, predictive factors were also determined in simplex and multiplex families.Conclusions: Our results show that individuals coming from multiplex families are at greater risks of a broad range of narcolepsy symptoms compared to simplex families. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the clinical evaluation of the tuberculosis drug delamanid.

Problem New drugs for infectious diseases often need to be evaluated in low-resource settings. While people working in such settings often provide high-quality care and perform operational research activities, they generally have less experience in conducting clinical trials designed for drug approval by stringent regulatory authorities. Approach We carried out a capacity-building programme during a multi-centre randomized controlled trial of delamanid, a new drug for the treatment of multidrug-resistant tuberculosis. The programme included: (i) site identification and needs assessment; (ii) achieving International Conference on Harmonization -- Good Clinical Practice (ICH-GCP) standards; (iii) establishing trial management; and (iv) increasing knowledge of global and local regulatory issues. Local setting Trials were conducted at 17 sites in nine countries (China, Egypt, Estonia, Japan, Latvia, Peru, the Philippines, the Republic of Korea and the United States of America). Eight of the 10 sites in low-resource settings had no experience in conducting the requisite clinical trials. Relevant changes Extensive capacity-building was done in all 10 sites. The programme resulted in improved local capacity in key areas such as trial design, data safety and monitoring, trial conduct and laboratory services. Lessons learnt Clinical trials designed to generate data for regulatory approval require additional efforts beyond traditional researchcapacity strengthening. Such capacity-building approaches pr [ABSTRACT FROM AUTHOR]

Background: Clinically effective and cost-effective methods for managing problematic sexual behaviour in adolescents are urgently needed. Adolescents who show problematic sexual behaviour have a range of negative psychosocial outcomes, and they and their parents can experience stigma, hostility and rejection from their community. Multisystemic therapy (MST) shows some evidence for helping to reduce adolescent sexual reoffending and is one of the few promising interventions available to young people who show problematic sexual behaviour. This paper describes the protocol for Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B), a feasibility trial of MST for problem sexual behaviour (MST-PSB) in antisocial adolescents at high risk of out-of-home placement due to problematic sexual behaviour.Methods/design: Eighty participants and their families recruited from five London boroughs will be randomized to MST-PSB or management as usual with follow-up to 20 months post-randomization. The primary outcome is out-of-home placement at 20 months. Secondary outcomes include sexual and non-sexual offending rates and antisocial behaviours, participant well-being, educational outcomes and total service and criminal justice sector costs. Feasibility outcomes include mapping the clinical service pathways needed to recruit adolescents displaying problematic sexual behaviour, acceptability of a randomized controlled trial to the key systems involved in managing these adolescents, and acceptability of the research protocol to young people and their families. Data will be gathered from police computer records, the National Pupil Database and interviews and self-report measures administered to adolescents and parents and will be analysed on an intention-to-treat basis.Discussion: The STEPS-B feasibility trial aims to inform policymakers, commissioners of services and professionals about the potential for implementing MST-PSB as an intervention for adolescents showing problem sexual behaviour. Should MST-PSB show potential, STEPS-B will determine what would be necessary to implement the programme more fully and at a scale that would warrant a full trial.Trial Registration: ISRCTN28441235 (registered 25 January 2012). [ABSTRACT FROM AUTHOR]

Randomized clinical trials are the most reliable approaches to evaluating the effects of new treatments and vaccines. During the 2014-2015 West African Ebola epidemic, many argued that such trials were neither ethical nor feasible in an environment of limited health infrastructure and severe disease with a high fatality rate. Consensus among the numerous organizations providing help to the affected areas was never achieved, resulting in fragmented collaboration, delayed study initiation and ultimately failure to provide definitive evidence on the efficacy of treatments and vaccines. Randomized trials were in fact approved by local ethics boards and initiated, demonstrating that randomized trials, even in such difficult circumstances, are feasible. Improved planning and collaboration among research and humanitarian organizations, and affected communities, in the interepidemic periods are needed to ensure that questions regarding the efficacy of vaccines and treatments can be definitively answered during future public health emergencies. [ABSTRACT FROM AUTHOR]

The article presents a study on the effectiveness of extended isoniazid therapy as treatment for tuberculosis in adults with HIV infection in Botswana. The study uses a randomized and placebo-controlled trial in which Cox regression analysis is used to estimate the effect of antiretroviral therapy and compare incident tuberculosis in groups. It is inferred that 36 months' isoniazid prophylaxis is effective for the prevention of tuberculosis than in 6-month prophylaxis in individuals with HIV.

The article presents a study on isoniazid tuberculosis preventive therapy (IPT) in Botswana where HIV-infected adults have access to antiretroviral therapy (ART). It uses of National IPT Program guidelines in the first screening of persons living with HIV (PLWH) while the second screening of the subjects was trial specific. It reveals that PLWH are relatively safe and well-tolerated considering six months of IPT and that adherence to IPT is more effective than receiving ART with IPT.

Background. We explored the association between antituberculosis drug pharmacokinetics and treatment outcomes among patients with pulmonary tuberculosis in Botswana. Methods. Consenting outpatients with tuberculosis had blood samples collected 1, 2, and 6 h after simultaneous isoniazid, rifampin, ethambutol, and pyrazinamide ingestion. Maximum serum concentrations (Cmax) and areas under the serum concentration time curve were determined. Clinical status was monitored throughout treatment. Results. Of the 225 participants, 36 (16%) experienced poor treatment outcome (treatment failure or death); 155 (69%) were infected with human immunodeficiency virus (HIV). Compared with published standards, low isoniazid Cmax occurred in 84 patients (37%), low rifampin Cmax in 188 (84%), low ethambutol Cmax in 87 (39%), and low pyrazinamide Cmax in 11 (5%). Median rifampin and pyrazinamide levels differed significantly by HIV status and CD4 cell count category. Only pyrazinamide pharmacokinetics were significantly associated with treatment outcome; low pyrazinamide Cmax was associated with a higher risk of documented poor treatment outcome, compared with normal Cmax (50% vs. 16%; P ! .01). HIV-infected patients with a CD4 cell count <200 cells/μL had a higher risk of poor treatment outcome (27%) than did HIV-uninfected patients (11%) or HIV-infected patients with a CD4 cell count ⩾200 cells/μL (12%; P = .01). After adjustment for HIV infection and CD4 cell count, patients with low pyrazinamide Cmax were 3 times more likely than patients with normal pyrazinamide Cmax to have poor outcomes (adjusted risk ratio, 3.38; 95% confidence interval, 1.84-6.22). Conclusions. Lower than expected antituberculosis drug Cmax occurred frequently, and low pyrazinamide Cmax was associated with poor treatment outcome. Exploring the global prevalence and significance of these findings may suggest modifications in treatment regimens that could improve tuberculosis cure rates. [ABSTRACT FROM AUTHOR]

The article evaluates commonly available pulmonary tuberculosis (TB) screening tests using sputum bacteriology as a gold standard in HIV-infected persons who attended an urban voluntary counseling and testing clinic in Addis Ababa, Ethiopia. It notes that all 438 HIV-infected persons underwent TB screening regardless of symptoms. It cites that the current Ethiopian national guidelines simulations showed 63% sensitivity and 83% specificity for diagnosing TB disease among study patients.

Background: In Southeast Asia, HIV-infected patients frequently die during TB treatment. Many physicians are reluctant to treat HIV-infected TB patients with anti-retroviral therapy (ART) and have questions about the added value of opportunistic infection prophylaxis to ART, the optimum ART regimen, and the benefit of initiating ART early during TB treatment. Methods: We conducted a multi-center observational study of HIV-infected patients newly diagnosed with TB in Thailand. Clinical data was collected from the beginning to the end of TB treatment. We conducted multivariable proportional hazards analysis to identify factors associated with death. Results: Of 667 HIV-infected TB patients enrolled, 450 (68%) were smear and/or culture positive. Death during TB treatment occurred in 112 (17%). In proportional hazards analysis, factors strongly associated with reduced risk of death were ART use (Hazard Ratio [HR] 0.16; 95% confidence interval [CI] 0.07-0.36), fluconazole use (HR 0.34; CI 0.18-0.64), and co-trimoxazole use (HR 0.41; CI 0.20-0.83). Among 126 patients that initiated ART after TB diagnosis, the risk of death increased the longer that ART was delayed during TB treatment. Efavirenz- and nevirapine-containing ART regimens were associated with similar rates of adverse events and death. Conclusion: Among HIV-infected patients living in Thailand, the single most important determinant of survival during TB treatment was use of ART. Controlled clinical trials are needed to confirm our findings that early ART initiation improves survival and that the choice of non-nucleoside reverse transcriptase inhibitor does not. [ABSTRACT FROM AUTHOR]

Abstract: Controlled trials have demonstrated that liquid media culture (LMC) is superior to solid media culture for diagnosis of Mycobacterium tuberculosis (MTB), but there is limited evidence about its performance in resource-limited settings. We evaluated the performance of LMC in a demonstration project in Bangkok, Thailand. Sputum specimens from persons with suspected or clinically diagnosed tuberculosis were inoculated in parallel on solid (Lowenstein–Jensen [LJ]) and liquid (mycobacterial growth indicator tube [MGIT 960]) media. Biochemical tests identified isolates as MTB or nontuberculosis mycobacteria (NTM). Of 2566 specimens received from October 2004 to September 2006, 1355 (53%) were culture positive by MGIT compared with 1013 (39%) by LJ. Median time to growth for MGIT was significantly less than LJ: 11 versus 27 days. Of 1417 isolates detected by at least 1 media, 1255 (86%) were identified as MTB and 162 (11%) NTM. MGIT improved speed and sensitivity of MTB isolation and drug susceptibility testing, regardless of HIV status. [Copyright &y& Elsevier]

Background: National guidelines recommend targeted tuberculin testing and treatment of latent tuberculosis infection (LTBI) among high-risk groups but discourage testing low-risk persons. Methods: We determined the LTBI prevalence (tuberculin skin test [TST] reaction ≥10 mm) among adults with and without TB exposure risk factors screened in Tennessee from 1/2/2002 to 4/19/2005. We then quantified LTBI risk among groups at high-risk for TB using multivariate analysis. Results: Of 53,061 adults tested, the LTBI prevalence was 34% among foreign-born persons, compared with 3.2% among nonforeign-born persons (prevalence odds ratio [POR] 15.7, 95% confidence interval [CI] 14.5-16.8). Among nonforeign-born adults, Asian race (POR 11.7, 95% CI 5.9-23.4), and Hispanic ethnicity (POR 11.7, 95% CI 9.0-15.2) were most strongly associated with LTBI. Only 2.4% of low-risk persons had LTBI. Conclusions: Risk-based screening can effectively distinguish persons who will benefit from LTBI testing and treatment. Targeted testing programs should prioritize foreign-born persons. Testing of low-risk persons is unnecessary. [ABSTRACT FROM AUTHOR]

Background: Of the 9.2 million new TB cases occurring each year, about 10% are in children. Because childhood TB is usually non-infectious and non-fatal, national programs do not prioritize childhood TB diagnosis and treatment. We reviewed data from a demonstration project to learn more about the epidemiology of childhood TB in Thailand. Methods: In four Thai provinces and one national hospital, we contacted healthcare facilities monthly to record data about persons diagnosed with TB, assist with patient care, provide HIV counseling and testing, and obtain sputum for culture and susceptibility testing. We analyzed clinical and treatment outcome data for patients age < 15 years old registered in 2005 and 2006. Results: Only 279 (2%) of 14,487 total cases occurred in children. The median age of children was 8 years (range: 4 months, 14 years). Of 197 children with pulmonary TB, 63 (32%) were bacteriologically-confirmed: 56 (28%) were smear-positive and 7 (4%) were smear-negative, but culture-positive. One was diagnosed with multi-drug resistant TB. HIV infection was documented in 75 (27%). Thirteen (17%) of 75 HIV-infected children died during TB treatment compared with 4 (2%) of 204 not known to be HIV-infected (p < 0.01). Conclusion: Childhood TB is infrequently diagnosed in Thailand. Understanding whether this is due to absence of disease or diagnostic effort requires further research. HIV contributes substantially to the childhood TB burden in Thailand and is associated with high mortality. [ABSTRACT FROM AUTHOR]

Objective WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB). The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004. Methods In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing. The catchment area included 3.6 million people in four provinces. We compared results from October 2004- September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003). Findings In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000). Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%. Private facilities diagnosed 634 (11%) of all TB cases. In 2005, 1392 (24%) cases were known to be HIV positive. The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 ( P< 0.01). Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%). Conclusion In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB. Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness. [ABSTRACT FROM AUTHOR]

Antiretroviral therapy (ART) is lifesaving in patients with advanced HIV infection, but the magnitude of benefit in HIV-infected patients receiving tuberculosis (TB) treatment remains uncertain, and population-based data from developing countries are limited. We prospectively collected data about HIV-infected TB patients from February 2003 through January 2004 in Ubon-ratchathani, Thailand. During 12 months, HIV was diagnosed in 329 (14%) of 2,342 patients registered for TB treatment. Of patients with known outcomes, death during TB treatment occurred in 5 (7%) of 71 who received ART and 94 (43%) of 219 who did not. Using multivariate analysis, we found a large reduction in the odds of death for patients receiving ART before or during TB treatment (odds ratio, 0.2; 95% confidence interval, 0.1-0.5), adjusting for CD4 count, smear status, co-trimoxazole use, and treatment facility. ART is associated with a substantial reduction in deaths during TB treatment for HIV-infected TB patients in Thailand. [ABSTRACT FROM AUTHOR]

Mycobacterium tuberculosis strains that are resistant to an increasing number of second-line drugs used to treat multidrug-resistant tuberculosis (MDR TB) are becoming a threat to public health worldwide. We surveyed the Network of Supranational Reference Laboratories for M. tuberculosis isolates that were resistant to second-line anti-TB drugs during 2000-2004. We defined extensively drug-resistant TB (XDR TB) as MDR TB with further resistance to >3 of the 6 classes of second-line drugs. Of 23 eligible laboratories, 14 (61%) contributed data on 17,690 isolates, which reflected drug susceptibility results from 48 countries. Of 3,520 (19.9%) MDR TB isolates, 347 (9.9%) met criteria for XDR TB. Further investigation of population-based trends and expanded efforts to prevent drug resistance and effectively treat patients with MDR TB are crucial for protection of public health and control of TB. [ABSTRACT FROM AUTHOR]

Summary Background The burden of tuberculosis is compounded by drug-resistant forms of the disease. This study aimed to analyse data on antituberculosis drug resistance gathered by the WHO and International Union Against Tuberculosis and Lung Disease Global Project on Anti-tuberculosis Drug Resistance Surveillance. Methods Data on drug susceptibility testing for four antituberculosis drugs-isoniazid, rifampicin, ethambutol, and streptomycin-were gathered in the third round of the Global Project (1999-2002) from surveys or ongoing surveillance in 79 countries or geographical settings. These data were combined with those from the first two rounds of the project and analyses were done. Countries that participated followed a standardised set of guidelines to ensure comparability both between and within countries. Findings The median prevalence of resistance to any of the four antituberculosis drugs in new cases of tuberculosis identified in 76 countries or geographical settings was 10·2% (range 0·0-57·1). The median prevalence of multidrug resistance in new cases was 1·0% (range 0·0-14·2). Kazakhstan, Tomsk Oblast (Russia), Karakalpakstan (Uzbekistan), Estonia, Israel, the Chinese provinces Liaoning and Henan, Lithuania, and Latvia reported prevalence of multidrug resistance above 6·5%. Trend analysis showed a significant increase in the prevalence of multidrug resistance in new cases in Tomsk Oblast (p<0·0001). Hong Kong (p=0·01) and the USA (p=0·0002) reported significant decreasing trends in multidrug resistance in new cases of tuberculosis. Interpretation Multidrug resistance represents a serious challenge for tuberculosis control in countries of the former Soviet Union and in some provinces of China. Gaps in coverage of the Global Project are substantial, and baseline information is urgently required from several countries with high tuberculosis burden to develop appropriate control interventions. [ABSTRACT FROM AUTHOR]

Abstract: On May 24–25, 2005 in Ann Arbor, Michigan, the US Environmental Protection Agency, the National Institute of Environmental Health Sciences, and the University of Michigan sponsored a technical workshop on the topic of connecting social and environmental factors to measure and track environmental health disparities. The workshop was designed to develop a transdisciplinary scientific foundation for exploring the conceptual issues, data needs, and policy applications associated with social and environmental factors used to measure and track racial, ethnic, and class disparities in environmental health. Papers, presentations, and discussions focused on the use of multilevel analysis to study environmental health disparities, the development of an organizing framework for evaluating health disparities, the development of indicators, and the generation of community-based participatory approaches for indicator development and use. Group exercises were conducted to identify preliminary lists of priority health outcomes and potential indicators and to discuss policy implications and next steps. Three critical issues that stem from the workshop were: (a) stronger funding support is needed for community-based participatory research in environmental health disparities, (b) race/ethnicity and socioeconomic position need to be included in environmental health surveillance and research, and (c) models to elucidate the interrelations between social, physical, and built environments should continue to be developed and empirically tested. [Copyright &y& Elsevier]

Evidence of successful management of multidrug-resistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1,047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings. [ABSTRACT FROM AUTHOR]

The article cites a retrospective cohort study from Latvia which aims to evaluate and compare time to and predictors of initial sputum culture conversion with predictors of initial sputum culture conversion with predictors of treatment outcome for patients with multidrug-resisant tuberculosis. The study is significant for identifying the efficacy of anti-tuberculosis pharmacologic treatment for multidrug-resistant disease.

Summary Background Latvia has one of the highest rates of multidrug-resistant tuberculosis (MDRTB). Our aim was to assess treatment outcomes for the first full cohort of MDRTB patients treated under Latvia's DOTS-Plus strategy following WHO guidelines. Methods We retrospectively reviewed all civilian patients who began treatment with individualised treatment regimens for pulmonary MDRTB in Latvia between Jan 1, and Dec 31, 2000. We applied treatment outcome definitions for MDRTB, developed by an international expert consensus group,and assessed treatment effectiveness and risk factors associated with poor outcome. Findings Of the 204 patients assessed, 55 (27%) had been newly diagnosed with MDRTB, and 149 (73%) had earlier been treated with first-line or second-line drugs for this disease. Assessment of treatment outcomes showed that 135 (66%) patients were cured or completed therapy, 14 (7%) died, 26 (13%) defaulted, and treatment failed in 29 (14%). Of the 178 adherent patients,135 (76%) achieved cure or treatment completion. In a multivariate Cox proportional-hazards model of these patients, independent predictors of poor outcome (death and treatment failure) included having previously received treatment for MDRTB (hazard ratio 5 ·7,95%CI 1·9--6·16), the use of five or fewer drugs for 3 months or more (3·2,1·1--9·6), resistance to ofloxacin (2·6,1 ·2 --5·4), and body-mass index less than 18·5 at start of treatment (2·3,1·1--4·9). Interpretation The DOTS-Plus strategy of identifying and treating patients with MDRTB can be effectivelyimplemented on a nationwide scale in a setting of limited resources. [ABSTRACT FROM AUTHOR]

A sensitive and accurate tuberculosis (TB) serodiagnostic test would aid in the control of TB, but results of current tests are relatively unreliable for persons infected with human immunodeficiency virus (HIV). We evaluated a new prototype immunochromatographic strip test and 5 commercially available serodiagnostic TB tests in a prospective study comprised of 465 consecutively enrolled patients with suspected TB from 2 hospitals in Botswana. Consenting adults underwent HIV testing, &ges;2 sputum smears and cultures, and mycobacterial blood culture. Patients were defined as having TB on the basis of any positive smear or culture. Between January and September 2002, 465 of 498 consecutive patients consented to enrollment. A total of 384 patients (83%) were infected with HIV, and 175 (38%) had TB; the mycobacterial blood culture was the sole source of diagnosis for 26 patients (15%) with TB. Among the tests evaluated, the sensitivity was 0%- 63%, the specificity was 39%-99%, the positive predictive value was 0%-39%, and the negative predictive value was 63%-65%. We conclude that the serodiagnostic tests evaluated in this study lacked sufficient sensitivity as sole tests for TB in this population. [ABSTRACT FROM AUTHOR]

Barrel centerline curvature is known to influence the location of projectile shot impacts. Superimposed on the unique manufactured barrel centerline is the flexed barrel shape that can occur prior to firing while the vehicle is on the move. In order to understand and quantify the effects of barrel flexure on gun accuracy, it is necessary to determine what combination of fundamental mode shapes is most likely to occur. A method to accomplish this task is described in this paper. The method is demonstrated by enumerating the 10 most likely flexed barrel shapes that were found to occur in a tank-mounted gun barrel while it traversed a bump course. [ABSTRACT FROM AUTHOR]