The diagnosis and treatment of early pulmonary tuberculosis in children

Recent investigations, conducted both in. the post mortem room and by means of the various Tuberculin .tests on.the living make it apparent.that Tuberculosis in Children, is a much commoner form of disease, and occurs at an earlier age,.than was formerly. imagined.In conclusion we would urge the vital necessity for early diagnosis in this.insidious disease, and the need of utilising every possible means of establishing the same. When the signs are definite, the symptoms well marked, it is often too late for hope of any permanent cure, . the case is now no longer early, but advanced. It is in the early stages that we must look to combat the disease with any degree of success.Tuberculin as a means of diagnosis may be of use, but it is a. two edged sword, and the danger of lighting up quiescent fool is too real to be lightly disregarded. In.the words of Sir Clifford Allbutt: there is too much at stake; and even for, the expert the number of 'normals' (or persons practically normal) who react is embarrassing In the stage preceding the presence of physical signs, we must look for slight irregularity of temperature - a sub- normal temperature in the morning is suspicious, 98.5 at that hour is too high and even more suspicious (Clifford Allbutt and most characteristic, one with a swing from 97°-99° at night. A feeling of.tiredness, general malnutrition, poor chest development and expansion, with deficient air entry, all these go,towards establishing an affirmative diagnosis. A positive von Pirquet's reaction - with certain reservations -'and, on X raying, a restricted movement of the diaphragm on one or other side, or shadows round. the roots of the lungs are confirmatory; while a family history of phthisis or exposure to infection must give additional weight to the evidence. The opsofic Index in skilled hands may afford valuable information.The earliest physical sign of value is the continued presence of crepitations, brought out often only by coughing. When expectoration is present the presence of Tubercle bacilli makes the diagnosis certain.With regard to treatment, we shall increase the patient's resistance by an open air life, by a diet With a due proportion of proteid and fat, the latter added to by cod liver oil, and by.the exhibition of creosote. We shall regulate his auto-innoculation by rest, coupled with graduated exercises and labour, and in suitable cases by the use of Tuberculin. The exercises should aid in improving the general musculature,.the chest expansion and development and.the air entry.Preventitive treatment consists in removing the child from debilitating: conditions, and surroundings, in his avoidance of chills and colds, and in attending to his teeth, throat, bowels and other organs and functions, so that a high standard of health may be reached and maintained

Secular trends in under-reporting in young people

Original article can be found at: http://journals.cambridge.org/action/displayJournal?jid=BJN Copyright The Authors. DOI: 10.1079/BJN20041307National survey data show that reported energy intake has decreased in recent decades despite a rise in the prevalence of obesity. This disparity may be due to a secular increase in under-reporting or a quantitatively greater decrease in energy expenditure. This study examines the extent of under-reporting of energy intake in the National Diet and Nutrition Survey (NDNS) in young people aged 4–18 years in 1997 using published equations to calculate estimated energy requirements. It explores secular changes by comparison with the Diets of British School Children (DBSC) survey in 10–11- and 14–15-year-olds in 1983. In the NDNS, under-reporting (estimated energy requirements – energy intake) represented 21 % of energy needs in girls and 20 % in boys. The magnitude of under-reporting increased significantly with age (P<0·001) and was higher in overweight than lean individuals over 7 years of age. To compare reported energy intake in DBSC and NDNS, the estimated physical activity level from dietary records (dPAL=reported energy intake/predicted BMR) was calculated. If there were no under-reporting, dPAL would represent the subject's true activity level. However, dPAL from the NDNS was significantly lower than that from the DBSC by 8 % and 9 % in boys and girls for those aged 10–11 years, and by 14 % and 11 % for 14–15-year-olds respectively, reaching physiologically implausible levels in the 14–15-year-old girls (dPAL=1·17). If activity levels have remained constant between the two surveys, under-reporting has increased by 8–14 %. The evidence supports a secular trend towards increased under-reporting between the two surveys, but the precise magnitude cannot be quantified in the absence of historical measures of energy expenditure.Peer reviewe

Where are the missing gamma ray burst redshifts?

In the redshift range z = 0-1, the gamma ray burst (GRB) redshift distribution should increase rapidly because of increasing differential volume sizes and strong evolution in the star formation rate. This feature is not observed in the Swift redshift distribution and to account for this discrepancy, a dominant bias, independent of the Swift sensitivity, is required. Furthermore, despite rapid localization, about 40-50% of Swift and pre-Swift GRBs do not have a measured redshift. We employ a heuristic technique to extract this redshift bias using 66 GRBs localized by Swift with redshifts determined from absorption or emission spectroscopy. For the Swift and HETE+BeppoSAX redshift distributions, the best model fit to the bias in z < 1 implies that if GRB rate evolution follows the SFR, the bias cancels this rate increase. We find that the same bias is affecting both Swift and HETE+BeppoSAX measurements similarly in z < 1. Using a bias model constrained at a 98% KS probability, we find that 72% of GRBs in z < 2 will not have measurable redshifts and about 55% in z > 2. To achieve this high KS probability requires increasing the GRB rate density in small z compared to the high-z rate. This provides further evidence for a low-luminosity population of GRBs that are observed in only a small volume because of their faintness.Comment: 5 pages, submitted to MNRA

Probing the low-luminosity GRB population with new generation satellite detectors

We compare the detection rates and redshift distributions of low-luminosity (LL) GRBs localized by Swift with those expected to be observed by the new generation satellite detectors on GLAST (now Fermi) and, in future, EXIST. Although the GLAST burst telescope will be less sensitive than Swift's in the 15--150 keV band, its large field-of-view implies that it will double Swift's detection rate of LL bursts. We show that Swift, GLAST and EXIST should detect about 1, 2 & 30 LL GRBs, respectively, over a 5-year operational period. The burst telescope on EXIST should detect LL GRBs at a rate of more than an order of magnitude greater than that of Swift's BAT. We show that the detection horizon for LL GRBs will be extended from $z \simeq 0.4$ for Swift to $z \simeq 1.1$ in the EXIST era. Also, the contribution of LL bursts to the observed GRB redshift distribution will contribute to an identifiable feature in the distribution at $z \simeq 1$.Comment: 6 pages, 4 figures, accepted by MNRA

Future change in ocean productivity: Is the Arctic the new Atlantic?

One of the most characteristic features in ocean productivity is the North Atlantic spring bloom. Responding to seasonal increases in irradiance and stratification, surface phytopopulations rise significantly, a pattern that visibly tracks poleward into summer. While blooms also occur in the Arctic Ocean, they are constrained by the sea-ice and strong vertical stratification that characterize this region. However, Arctic sea-ice is currently declining, and forecasts suggest this may lead to completely ice-free summers by the mid-21st century. Such change may open the Arctic up to Atlantic-style spring blooms, and do so at the same time as Atlantic productivity is threatened by climate change-driven ocean stratification. Here we use low and high-resolution instances of a coupled ocean-biogeochemistry model, NEMO-MEDUSA, to investigate productivity. Drivers of present-day patterns are identified, and changes in these across a climate change scenario (IPCC RCP 8.5) are analyzed. We find a globally significant decline in North Atlantic productivity (&gt; ?20%) by 2100, and a correspondingly significant rise in the Arctic (&gt; +50%). However, rather than the future Arctic coming to resemble the current Atlantic, both regions are instead transitioning to a common, low nutrient regime. The North Pacific provides a counterexample where nutrients remain high and productivity increases with elevated temperature. These responses to climate change in the Atlantic and Arctic are common between model resolutions, suggesting an independence from resolution for key impacts. However, some responses, such as those in the North Pacific, differ between the simulations, suggesting the reverse and supporting the drive to more fine-scale resolutions

A small yeast RNA selectively inhibits internal initiation of translation programmed by poliovirus RNA: specific interaction with cellular proteins that bind to the viral 5'-untranslated region

We have purified, sequenced, and prepared a synthetic clone of a small (60-nucleotide) RNA molecule from the yeast Saccharomyces cerevisiae that had previously been isolated on the basis of its ability to selectively block the translation of poliovirus mRNA. RNA derived from the clone by transcription with T7 RNA polymerase appears to block translation initiation by internal ribosome entry (cap independent) but does not significantly affect cap-dependent translation. Deletion analysis of the poliovirus 5'-untranslated region (5'-UTR) has shown that yeast inhibitor RNA (I-RNA) requires internal ribosome entry site sequences to inhibit the translation of poliovirus RNA in vitro. Using a bicistronic RNA construct, we show that I-RNA preferentially inhibits translation by internal ribosome entry. Gel retardation and UV cross-linking studies demonstrate that I-RNA specifically binds proteins which interact with RNA secondary structures within the poliovirus 5'-UTR presumably involved in internal initiation. Specifically, purified I-RNA competes with virus RNA structures within the 5'-UTR which bind a cellular protein with an approximate molecular mass of 52 kDa. Finally, when transfected into HeLa cells, I-RNA efficiently inhibits the replication of poliovirus RNA presumably by inhibiting translation of the input virus RNA