Clinical standards for the assessment, management, and rehabilitation of post-TB lung disease

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR). METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement). RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR. CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD

The clinical syndrome of specific antibody deficiency in children

Specific antibody deficiency (SAD) is an immune deficiency which has been reported in adults and children with recurrent respiratory tract infections; however, the clinical features of SAD are not well described. This study evaluated formally the clinical syndrome of SAD, by comparing the clinical features of children with SAD and those of children with recurrent infection but normal immune function tests. SAD was defined as an adequate IgG antibody response to less than 50% of 12 pneumococcal serotypes tested following 23-valent unconjugated pneumococcal immunization. An adequate IgG antibody response was defined as a post-immunization titre of ≥ 1·3 µg/ml or ≥ four times the preimmunization value. Seventy-four children with recurrent infection were evaluated where immune deficiencies other than SAD had been excluded. Eleven (14·9%) of these children had SAD. Clinical features differed between the group with SAD and the group with normal antibody responses. A history of otitis media, particularly in association with chronic otorrhoea was associated with SAD [relative risk (RR) of SAD in those with chronic otorrhoea 4·64 (P = 0·02)]. SAD was associated with allergic disease, particularly allergic rhinitis [RR of SAD in those with allergic rhinitis 3·77 (P = 0·04)]. These two clinical associations of SAD were independent in this study [RR of chronic otorrhoea in those with allergic rhinitis 0·85 (P = 0·28)]. SAD was not an age-related phenomenon in this population. SAD has a distinct clinical phenotype, presenting as recurrent infection associated with chronic otorrhoea and/or allergic disease, and the condition should be sought in children with these features

Integration of a real-time stochastic routing optimization software with an enterprise resource planner

In order to manage their activities in a centralized manner, an Enterprise Resource Planning (ERP) software is a fundamental tool to many companies. As a generic software, many times it's necessary to add new functionalities to the ERP in order to improve and to adapt/suite it to the companies' processes. The Intelligent Fresh Food Fleet Router (i3FR) project aims to meet the needs expressed by several companies, namely the usefulness of a tool that makes "intelligent" management of the food distribution logistics. This "intelligence" presupposes interconnection capacity of various platforms (e.g., fleet management, GPS, and logistics), and active communication between them in order to optimize and enable integrated decisions.This paper presents a multi-layered architecture to integrate existing ERPs with a route optimization and a temperature data acquisition module. The optimization module is prepared to deal with dynamic scenarios, as new demands may appear during the optimization process and the routes will admit several states (e.g., open, locked and closed), according with the ERP manager instructions. The data aquisition module implements the retrieve of some vehicles parameters (e.g., chambers' temperatures and vehicle's global positioning system data), used to validate the routes and provide information to the company's manager.A distribution company was selected as case-study, having up to 5000 daily deliveries and a fleet of 120 vehicles. The integration of the developed modules with the company's ERP allowed the maintainance of most of the existing procedures, avoiding routines disruption