Diagnostic accuracy of TB-LAMP for pulmonary tuberculosis: a systematic review and meta-analysis.

BACKGROUND:The need for a rapid, molecular test to diagnose tuberculosis (TB) has prompted exploration of TB-LAMP (Eiken; Tokyo, Japan) for use in resource-limited settings. We conducted a systematic review to assess the accuracy of TB-LAMP as a diagnostic test for pulmonary TB. METHODS:We analyzed individual-level data for eligible patients from all studies of TB-LAMP conducted between Jan 2012 and October 2015 to compare the diagnostic accuracy of TB-LAMP with that of smear microscopy and Xpert MTB/RIF® using 3 reference standards of varying stringency. Pooled sensitivity and specificity and pooled differences in sensitivity and specificity were estimated using random effects meta-analysis. Study quality was evaluated using QUADAS-2. RESULTS:Four thousand seven hundred sixty individuals across 13 studies met eligibility criteria. Methodological quality was judged to be low for all studies. TB-LAMP had higher sensitivity than sputum smear microscopy (pooled sensitivity difference + 13·2, 95% CI 4·5-21·9%) and similar sensitivity to Xpert MTB/RIF (pooled sensitivity difference - 2·5, 95% CI -8·0 to + 2·9) using the most stringent reference standard available. Specificity of TB-LAMP was similar to that of sputum smear microscopy (pooled specificity difference - 1·8, 95% CI -3·8 to + 0·2) and Xpert MTB/RIF (pooled specificity difference 0·5, 95% CI -0·9 to + 1·8). CONCLUSIONS:From the perspective of diagnostic accuracy, TB-LAMP may be considered as an alternative test for sputum smear microscopy. Additional factors such as cost, feasibility, and acceptability in settings that continue to rely on sputum smear microscopy should be considered when deciding to adopt this technology. Xpert MTB/RIF should continue to be preferred in settings where resource and infrastructure requirements are adequate and where HIV co-infection or drug-resistance is of concern

Essays on Newspaper Economics.

This dissertation consists of two chapters that focus on estimating the economic impact of two major pricing changes witnessed recently in the U.S. newspaper industry. The first chapter investigates the optimality of the decision adopted by print newspaper publishers to increase subscription prices notwithstanding a declining preference among readers for newspaper consumption. Further, it proposes and evaluates theoretical explanations for the increasing subscription price trajectory in this market. Of the three available subscription options in print (Daily, Weekend and Sunday only), subscription prices increased more steeply for the Daily option; this is consistent with the view that newspapers are driving away low valuation Daily option readers but not Sunday, as Sunday contributes higher ad revenues. As an extreme case of this strategy, several newspapers have adopted a policy change by limiting production/distribution of the newspaper only to weekends. A counterfactual simulation shows the implications of such a policy change and offers implications for effective newspaper product portfolio management. Second, over the last few years, another popular strategy among newspaper publishers operating online editions is the creation of paywalls (i.e., the practice of charging online readers a subscription fee for accessing news content). News publishers' objectives from setting up paywalls are believed to be threefold: a) creating a new revenue stream by monetizing online news content in the reader market, b) preserving the more lucrative print subscription revenues by discouraging print readers from switching to free online newspapers, and c) increasing the newspaper's ability to charge higher ad rates by promoting a subscription base of paying readers. It is unclear whether charging readers for online access will unambiguously serve all the expected objectives especially since the paywalls run the risk of leading to heavy attrition of readers and hence, advertisers. The second chapter employs readership and advertising data for the New York Times, a newspaper that has been cited in the media for its successful paywall execution, to investigate the effects of its paywall launch on online readership, print circulation and online advertising revenues.PhDBusiness AdministrationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/109057/1/adithyap_1.pd

DNA Computing Using Cryptographic and Steganographic Strategies

Information protection and secrecy are major concerns, especially regarding the internet’s rapid growth and widespread usage. Unauthorized database access is becoming more common and is being combated using a variety of encrypted communication methods, such as encryption and data hiding. DNA cryptography and steganography are used as carriers by utilizing the bio-molecular computing properties that have become more common in recent years. This study examines recently published DNA steganography algorithms, which use DNA to encrypt confidential data transmitted through an insecure communication channel. Several DNA-based steganography strategies will be addressed, with a focus on the algorithm’s advantages and drawbacks. Probability cracking, blindness, double layer of security, and other considerations are used to compare steganography algorithms. This research would help and create more effective and accurate DNA steganography strategies in the future

(E)-3-Methyl-4-[(2-oxidoquinolin-1-ium-3-yl)methyl­eneamino]-1H-1,2,4-triazole-5(4H)-thione N,N-dimethyl­formamide solvate

The title 1,2,4-triazole compound, C13H11N5OS·C3H7NO, crystallizes as a 1:1 dimethyl­formamide (DMF) solvate. The main mol­ecule exists in a trans configuration with respect to the acyclic C=N bond. An intra­molecular C—H⋯S hydrogen bond generates an S(6) ring motif. In the synthesis, a proton is transferred from the O atom of a hydr­oxy group to the quinoline group N atom. The essentially planar triazole ring and quinoline ring system [maximum deviations of 0.001 (2) and 0.013 (2) Å, respectively] form a dihedral angle of 5.86 (9)°. In the crystal structure, mol­ecules of (E)-4-[(2-hydroxy-3-­quinolyl)methyl­eneamino]-3-methyl-1H-1,2,4-triazole-5(4H)-thione are linked into R 2 2(8) centrosymmteric dimers via N—H⋯O hydrogen bonds. These dimers are further linked into an extended three-dimensional structure by the DMF solvent mol­ecules via inter­molecular N—H⋯O and C—H⋯O hydrogen bonds. The crystal structure is consolidated by two different inter­molecular π–π inter­actions [centroid–centroid distances = 3.6593 (12) and 3.6892 (12) Å]

Outlook for tuberculosis elimination in California: An individual-based stochastic model.

RationaleAs part of the End TB Strategy, the World Health Organization calls for low-tuberculosis (TB) incidence settings to achieve pre-elimination (<10 cases per million) and elimination (<1 case per million) by 2035 and 2050, respectively. These targets require testing and treatment for latent tuberculosis infection (LTBI).ObjectivesTo estimate the ability and costs of testing and treatment for LTBI to reach pre-elimination and elimination targets in California.MethodsWe created an individual-based epidemic model of TB, calibrated to historical cases. We evaluated the effects of increased testing (QuantiFERON-TB Gold) and treatment (three months of isoniazid and rifapentine). We analyzed four test and treat targeting strategies: (1) individuals with medical risk factors (MRF), (2) non-USB, (3) both non-USB and MRF, and (4) all Californians. For each strategy, we estimated the effects of increasing test and treat by a factor of 2, 4, or 10 from the base case. We estimated the number of TB cases occurring and prevented, and net and incremental costs from 2017 to 2065 in 2015 U.S. dollars. Efficacy, costs, adverse events, and treatment dropout were estimated from published data. We estimated the cost per case averted and per quality-adjusted life year (QALY) gained.Measurements and main resultsIn the base case, 106,000 TB cases are predicted to 2065. Pre-elimination was achieved by 2065 in three scenarios: a 10-fold increase in the non-USB and persons with MRF (by 2052), and 4- or 10-fold increase in all Californians (by 2058 and 2035, respectively). TB elimination was not achieved by any intervention scenario. The most aggressive strategy, 10-fold in all Californians, achieved a case rate of 8 (95% UI 4-16) per million by 2050. Of scenarios that reached pre-elimination, the incremental net cost was $20 billion (non-USB and MRF) to$48 billion. These had an incremental cost per QALY of $657,000 to$3.1 million. A more efficient but somewhat less effective single-lifetime test strategy reached as low as $80,000 per QALY.ConclusionsSubstantial gains can be made in TB control in coming years by scaling-up current testing and treatment in non-USB and those with medical risks

Preclinical toxicological evaluation of Aloe vera health drinks in wistar rats

Human consumption of Aloe vera as a beverage has recently increased in popularity. These benefits are controversial with some sources pointing out that the putative effects of aloe are unsupported by clinical studies; it is important that marketed products be tested for toxicities following oral consumption. Hence this study was designed to evaluate the toxicological effect of marketed aloe health drinks. Thirty either sex Wistar rats (200-300gm) were enrolled in this study and are divided into 5 groups. Group I receives Normal saline serves as vehicle control, Group II and III receives Product A- Low dose (0.5 ml twice daily, p.o) and High dose (1.0 ml twice daily, p.o) respectively. Group IV and V receives Product B- Low dose (0.5 ml twice daily, p.o) and High dose (1.0 ml twice daily, p.o) respectively. Weekly body weight and daily feed intake were measured. On 28th day total urine output volume, faecal consistency, Haematological, biochemical, and organ weight were measured to assess the toxicity of aloe health drinks. The result of this study shows that continuous usage of aloe health drinks showed milder weight reduction, significant improvement in erythropoiesis also it increases the WBC count and increases the weight of spleen it may confirm the immune modulatory effect of aloe health drink. At the higher doses, it increased the SGOT, SGPT, serum urea and creatinine it may lead to the hepatotoxicity and nephrotoxicity. In gastrointestinal tract on prolonged uses, it produced few lesions and diarrhoea. It might be concluded that prolonged consumption of unprocessed aloe health drink contains latex, an ingredient which has many health risks associated with it. So it can aggravate health problems

Implementation science to improve the quality of tuberculosis diagnostic services in Uganda.

Nucleic acid amplification tests such as Xpert MTB/RIF (Xpert) have the potential to revolutionize tuberculosis (TB) diagnostics and improve case finding in resource-poor settings. However, since its introduction over a decade ago in Uganda, there remain significant gaps along the cascade of care for patients undergoing TB diagnostic evaluation at peripheral health centers. We utilized a systematic, implementation science-based approach to identify key reasons at multiple levels for attrition along the TB diagnostic evaluation cascade of care. Provider- and health system-level barriers fit into four key thematic areas: human resources, material resources, service implementation, and service coordination. Patient-level barriers included the considerable costs and time required to complete health center visits. We developed a theory-informed strategy using the PRECEDE framework to target key barriers by streamlining TB diagnostic evaluation and facilitating continuous quality improvement. The resulting SIMPLE TB strategy involve four key components: 1) Single-sample LED fluorescence microscopy; 2) Daily sputum transport to Xpert testing sites; 3) Text message communication of Xpert results to health centers and patients; and 4) Performance feedback to health centers using a quality improvement framework. This combination of interventions was feasible to implement and significantly improved the provision of high-quality care for patients undergoing TB diagnostic evaluation. We conclude that achieving high coverage of Xpert testing services is not enough. Xpert scale-up should be accompanied by health system co-interventions to facilitate effective implementation and ensure that high quality care is delivered to patients