Added value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.

SETTING: Bleach sedimentation is a method used to increase the diagnostic yield of sputum microscopy for countries with a high prevalence of human immunodeficiency virus (HIV) infection and limited resources. OBJECTIVES: To compare the relative cost-effectiveness of different microscopy approaches in diagnosing tuberculosis (TB) in Kenya. METHODS: An analytical decision tree model including cost and effectiveness measures of 10 combinations of direct (D) and overnight bleach (B) sedimentation microscopy was constructed. Data were drawn from the evaluation of the bleach sedimentation method on two specimens (first on the spot [1] and second morning [2]) from 644 TB suspects in a peripheral health clinic. Incremental cost per smear-positive detected case was measured. Costs included human resources and materials using a micro-costing evaluation. RESULTS: All bleach-based microscopy approaches detected significantly more cases (between 23.3% for B1 and 25.9% for B1+B2) than the conventional D1+D2 approach (21.0%). Cost per tested case ranged between respectively euro 2.7 and euro 4.5 for B1 and B1+D2+B2. B1 and B1+B2 were the most cost-effective approaches. D1+B2 and D1+B1 were good alternatives to avoid using approaches exclusively based on bleach sedimentation microscopy. CONCLUSIONS: Among several effective microscopy approaches used, including sodium hypochlorite sedimentation, only some resulted in a limited increase in the laboratory workload and would be most suitable for programmatic implementation

Reducing the Number of Sputum Samples Examined and Thresholds for Positivity: An Opportunity to Optimise Smear Microscopy.

SETTING: Urban health clinic, Nairobi. OBJECTIVE: To evaluate the impact on tuberculosis (TB) case detection and laboratory workload of reducing the number of sputum smears examined and thresholds for diagnosing positive smears and positive cases. DESIGN: In this prospective study, three Ziehl-Neelsen stained sputum smears from consecutive pulmonary TB suspects were examined blind. The standard approach (A), > or = 2 positive smears out of 3, using a cut-off of 10 acid-fast bacilli (AFB)/100 high-power fields (HPF), was compared with approaches B, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3, one of which is > or = 10 AFB/100 HPF; C, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3; D, > or = 1 positive smear (> or = 10 AFB/100 HPF) out of 2; and E, > or = 1 positive smear (> or = 4 AFB/100 HPF) out of 2. The microscopy gold standard was detection of at least one positive smear (> or = 4 AFB/100 HPF) out of 3. RESULTS: Among 644 TB suspects, the alternative approaches detected from 114 (17.7%) (approach B) to 123 cases (19.1%) (approach E) compared to 105 cases (16.3%) for approach A (P < 0.005). Sensitivity ranged between 82.0% (105/128) for A and 96.1% (123/128) for E. The single positive smear approaches reduced the number of smears by 36% compared to approach A. CONCLUSION: Reducing the number of specimens and the positivity threshold to define a positive case increased the sensitivity of microscopy and reduced laboratory workload

Investigation of collective radial expansion and stopping in heavy ion collisions at Fermi energies

We present an analysis of multifragmentation events observed in central Xe+Sn reactions at Fermi energies. Performing a comparison between the predictions of the Stochastic Mean Field (SMF) transport model and experimental data, we investigate the impact of the compression-expansion dynamics on the properties of the final reaction products. We show that the amount of radial collective expansion, which characterizes the dynamical stage of the reaction, influences directly the onset of multifragmentation and the kinematic properties of multifragmentation events. For the same set of events we also undertake a shape analysis in momentum space, looking at the degree of stopping reached in the collision, as proposed in recent experimental studies. We show that full stopping is achieved for the most central collisions at Fermi energies. However, considering the same central event selection as in the experimental data, we observe a similar behavior of the stopping power with the beam energy, which can be associated with a change of the fragmentation mechanism, from statistical to prompt fragment emission.Comment: 15 page

Scaling Behavior of the Landau Gauge Overlap Quark Propagator

The properties of the momentum space quark propagator in Landau gauge are examined for the overlap quark action in quenched lattice QCD. Numerical calculations are done on three lattices with different lattice spacings and similar physical volumes to explore the approach of the quark propagator towards the continuum limit. We have calculated the nonperturbative momentum-dependent wavefunction renormalization function $Z(p^2)$ and the nonperturbative mass function $M(p^2)$ for a variety of bare quark masses and extrapolate to the chiral limit. We find the behavior of $Z(p^2)$ and $M(p^2)$ are in good agreement for the two finer lattices in the chiral limit. The quark condensate is also calculated.Comment: 3 pages, Lattice2003(Chiral fermions

Benign Bilateral Adenomyoepithelioma of the Mammary Gland in a Ring-tailed Lemur (Lemur catta)

Naturally occurring mammary tumours are uncommon in prosimians. A 20-year-old female ring-tailed lemur (Lemur catta) developed bilateral enlargement of the mammary glands. Surgical removal revealed that both masses were comprised of multiple nodules and cystic areas that entirely replaced the normal glands. Histologically, a benign neoplastic biphasic cellular proliferation, composed of luminal–epithelial and basal–myoepithelial components, was identified. Immunohistochemical analysis for expression of cytokeratin (CK) AE1/AE3, CK7, CK5 + 8, CK14, vimentin, p63 and 14-3-3σ highlighted the biphasic nature of the neoplasm. A low mitotic count, low Ki67 labelling index, expression of oestrogen receptor-α, lack of expression of human epidermal growth factor receptor and a 3-year disease-free period without recurrence supported the benign nature of the tumour. Macroscopically, histologically and immunohistochemically this neoplasm resembled benign adenomyoepithelioma of the breast in women. This is the first complete report of a naturally occurring mammary tumour in a ring-tailed lemur

Pseudo-critical clusterization in nuclear multifragmentation

In this contribution we show that the biggest fragment charge distribution in central collisions of Xe+Sn leading to multifragmentation is an admixture of two asymptotic distributions observed for the lowest and highest bombarding energies. The evolution of the relative weights of the two components with bombarding energy is shown to be analogous to that observed as a function of time for the largest cluster produced in irreversible aggregation for a finite system. We infer that the size distribution of the largest fragment in nuclear multifragmentation is also characteristic of the time scale of the process, which is largely determined by the onset of radial expansion in this energy range.Comment: 4 pages, 3 figures, Contribution to conference proceedings of the 25th International Nuclear Physics Conference (INPC 2013

Infinite Volume and Continuum Limits of the Landau-Gauge Gluon Propagator

We extend a previous improved action study of the Landau gauge gluon propagator, by using a variety of lattices with spacings from $a = 0.17$ to 0.41 fm, to more fully explore finite volume and discretization effects. We also extend a previously used technique for minimizing lattice artifacts, the appropriate choice of momentum variable or ``kinematic correction'', by considering it more generally as a ``tree-level correction''. We demonstrate that by using tree-level correction, determined by the tree-level behavior of the action being considered, it is possible to obtain scaling behavior over a very wide range of momenta and lattice spacings. This makes it possible to explore the infinite volume and continuum limits of the Landau-gauge gluon propagator.Comment: 24 pages RevTex, 18 figures; Responses to referee comments, minor change

Sequential fissions of heavy nuclear systems

In Xe+Sn central collisions from 12 to 20 MeV/A measured with the INDRA 4$\pi$ multidetector, the three-fragment exit channel occurs with a significant cross section. In this contribution, we show that these fragments arise from two successive binary splittings of a heavy composite system. Strong Coulomb proximity effects are observed in the three-fragment final state. By comparison with Coulomb trajectory calculations, we show that the time scale between the consecutive break-ups decreases with increasing bombarding energy, becoming compatible with quasi-simultaneous multifragmentation above 18 MeV/A.Comment: 6 pages, 5 figures, contribution to conference proceedings of the Fifth International Workshop on Nuclear fission and Fission-Product Spectroscop