How health systems in sub-Saharan Africa can benefit from tuberculosis and other infectious disease programmes.

Weak and dysfunctional health systems in low-income countries, particularly in sub-Saharan Africa, are recognised as major obstacles to attaining the health-related Millennium Development Goals by 2015. Some progress is being made towards achieving the targets of Millennium Development Goal 6 for tuberculosis (TB), HIV/AIDS and malaria, with the achievements largely resulting from clearly defined strategies and intervention delivery systems combined with large amounts of external funding. This article is divided into four main sections. The first highlights the crucial elements that are needed in low-income countries in sub-Saharan Africa to deliver good quality health care through general health systems. The second discusses the main characteristics of infectious disease and TB control programmes. The third illustrates how TB control and other infectious disease programmes can help to strengthen these components, particularly in human resources; infrastructure; procurement and distribution; monitoring, evaluation and supervision; leadership and stewardship. The fourth and final section looks at progress made to date at the international level in terms of policy and guidelines, with some specific suggestions about this might be moved forward at the national level. For TB and other infectious disease programmes to drive broad improvements in health care systems and patient care, the lessons that have been learnt must be consciously applied to the broader health system, and sufficient financial input and the engagement of all players are essential

Fluorescence Properties of Photonic Crystals Doped with Perylenediimide

This study aims to present the fabrication of colloidal photonic crystals (PC) with increased fluorescence properties. The use of a highly fluorescent perylenediimide derivate (PDI) during the soap-free emulsion polymerization of styrene–acrylic acid resulted in monodisperse core–shell particles which allowed the fabrication of PC films. The properties of the hybrid material were studied in comparison with hybrid materials obtained by impregnation of films with chromophore solutions. In both cases an increase of the fluorescence response was observed in addition to a blue shift for the PDI core particles, proving the incorporation of the dye inside the copolymer particles

Radiographic characteristics of rifampicin-resistant tuberculosis in the STREAM stage 1 trial and their influence on time to culture conversion in the short regimen

Background: Stage 1 of the STREAM trial demonstrated that the 9 month (Short) regimen developed in Bangladesh was non-inferior to the 20 month (Long) 2011 World Health Organization recommended regimen. We assess the association between HIV infection and radiographic manifestations of tuberculosis and factors associated with time to culture conversion in Stage 1 of the STREAM trial. Methods: Reading of chest radiographs was undertaken independently by two clinicians, and films with discordant reading were read by a third reader. Recording of abnormal opacity of the lung parenchyma included location (right upper, right lower, left upper, and left lower) and extent of disease (minimal, moderately-advanced, and far advanced). Time to culture conversion was defined as the number of days from initiation of treatment to the first of two consecutive negative culture results, and compared using the log-rank test, stratified by country. Cox proportional hazards models, stratified by country and adjusted for HIV status, were used to identify factors associated with culture conversion. Results: Of the 364 participants, all but one had an abnormal chest X-ray: 347 (95%) had opacities over upper lung fields, 318 (87%) had opacities over lower lung fields, 124 (34%) had far advanced pulmonary involvement, and 281 (77%) had cavitation. There was no significant association between HIV and locations of lung parenchymal opacities, extent of opacities, the presence of cavitation, and location of cavitation. Participants infected with HIV were significantly less likely to have the highest positivity grade (3+) of sputum culture (p = 0.035) as compared to participants not infected with HIV. Cavitation was significantly associated with high smear positivity grades (p < 0.001) and high culture positivity grades (p = 0.004) among all participants. Co-infection with HIV was associated with a shorter time to culture conversion (hazard ratio 1.59, 95% CI 1.05–2.40). Conclusions: Radiographic manifestations of tuberculosis among the HIV-infected in the era of anti-retroviral therapy may not differ from that among those who were not infected with HIV. Radiographic manifestations were not consistently associated with time to culture conversion, perhaps indicating that the Short regimen is sufficiently powerful in achieving sputum conversion across the spectrum of radiographic pulmonary involvements. Trial registration: ISRCTN ISRCTN78372190. Registered 14/10/2010. The date of first registration 10/02/2016

The Union and Médecins Sans Frontières approach to operational research.

Operational research (OR) has become a hot topic at national meetings, international conferences and donor fora. The International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) Operational Centre Brussels strongly promote and implement OR with colleagues in low- and middle-income countries. Here we describe how the two organisations define OR, and explain the guiding principles and methodology that underpin the strategy for developing and expanding OR in those countries. We articulate The Union's and MSF's approach to supporting OR, highlighting the main synergies and differences. Then, using the Malawi National Tuberculosis Control Programme as an example, we show how OR can be embedded within tuberculosis control activities, leading to changes in policy and practice at the national level. We discuss the difficult, yet vitally important, issue of capacity building, and share our vision of a new paradigm of product-related training and performance-based OR fellowships as two ways of developing the necessary skills at country level to ensure research is actually performed. Finally, we highlight the need to consider and incorporate into practice the ethical components of OR. This is a key moment to be involved in OR. We are confident that in partnership with interested stakeholders, including the World Health Organization, we can stimulate the implementation of quality, relevant OR as an integral part of health service delivery that in turn will lead to better health for people, particularly for those living in the poorer parts of the world

Graphene as Transparent Electrode for Direct Observation of Hole Photoemission from Silicon to Oxide

The outstanding electrical and optical properties of graphene make it an excellent alternative as a transparent electrode. Here we demonstrate the application of graphene as collector material in internal photoemission (IPE) spectroscopy; enabling the direct observation of both electron and hole injections at a Si/Al2O3 interface and successfully overcoming the long-standing difficulty of detecting holes injected from a semiconductor emitter in IPE measurements. The observed electron and hole barrier heights are 3.5 eV and 4.1 eV, respectively. Thus the bandgap of Al2O3 can be further deduced to be 6.5 eV, in close agreement with the valued obtained by vacuum ultraviolet spectroscopic ellipsometry analysis. The detailed optical modeling of a graphene/Al2O3/Si stack reveals that by using graphene in IPE measurements the carrier injection from the emitter is significantly enhanced and the contribution of carrier injection from the collector electrode is minimal. The method can be readily extended to various IPE test structures for a complete band alignment analysis and interface characterization.Comment: 15 pages, 5 figure

Reversible physical interaction between CdSe quantum dots and perylenediimide (PDI) aggregates in aqueous media

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Anionic polymerization by an electron transfer process from a CdSe quantum dot–perylenediimide (PDI) system

Reversible physical interactions between CdSe quantum dots (QDs) and perylenediimide (PDI) derivatives have been investigated. Original processes, dependent on the concentration of the two species, contact time, temperature and pH, were observed. The combining of the two solutions resulted in the formation of an electron transfer complex (ETC) due to the transfer of an electron from CdSe nanoparticles to PDI, followed by the formation of the final particularly stable dianion PDI2− species through another electron transfer process. The anionic species was employed for the polymerization initiation of glycidyl methacrylate (GMA). Some aspects of the anionic polymerization mechanism have been investigated

Investigation of the efficacy of the short regimen for rifampicin-resistant TB from the STREAM trial

Background: The STREAM trial demonstrated that a 9–11-month “short” regimen had non-inferior efficacy and comparable safety to a 20+ month “long” regimen for the treatment of rifampicin-resistant tuberculosis. Imbalance in the components of the composite primary outcome merited further investigation. / Methods: Firstly, the STREAM primary outcomes were mapped to alternatives in current use, including WHO programmatic outcome definitions and other recently proposed modifications for programmatic or research purposes. Secondly, the outcomes were re-classified according to the likelihood that it was a Failure or Relapse (FoR) event on a 5-point Likert scale: Definite, Probable, Possible, Unlikely, and Highly Unlikely. Sensitivity analyses were employed to explore the impact of informative censoring. The protocol-defined modified intention-to-treat (MITT) analysis population was used for all analyses. / Results: Cure on the short regimen ranged from 75.1 to 84.2% across five alternative outcomes. However, between-regimens results did not exceed 1.3% in favor of the long regimen (95% CI upper bound 10.1%), similar to the primary efficacy results from the trial. Considering only Definite or Probable FoR events, there was weak evidence of a higher risk of FoR in the short regimen, HR 2.19 (95%CI 0.90, 5.35), p = 0.076; considering only Definite FoR events, the evidence was stronger, HR 3.53 (95%CI 1.05, 11.87), p = 0.030. Cumulative number of grade 3–4 AEs was the strongest predictor of censoring. Considering a larger effect of informative censoring attenuated treatment differences, although 95% CI were very wide. / Conclusion: Five alternative outcome definitions gave similar overall results. The risk of failure or relapse (FoR) may be higher in the short regimen than in the long regimen, highlighting the importance of how loss to follow-up and other censoring is accounted for in analyses. The outcome of time to FoR should be considered as a primary outcome for future drug-sensitive and drug-resistant TB treatment trials, provided sensitivity analyses exploring the impact of departures from independent censoring are also included