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Aggressive Regimens for Multidrug-Resistant Tuberculosis Decrease All-Cause Mortality
Rationale: A better understanding of the composition of optimal treatment regimens for multidrug-resistant tuberculosis (MDR-TB) is essential for expanding universal access to effective treatment and for developing new therapies for MDR-TB. Analysis of observational data may inform the definition of an optimized regimen. Objectives: This study assessed the impact of an aggressive regimen–one containing at least five likely effective drugs, including a fluoroquinolone and injectable–on treatment outcomes in a large MDR-TB patient cohort. Methods: This was a retrospective cohort study of patients treated in a national outpatient program in Peru between 1999 and 2002. We examined the association between receiving an aggressive regimen and the rate of death. Measurements and Main Results: In total, 669 patients were treated with individualized regimens for laboratory-confirmed MDR-TB. Isolates were resistant to a mean of 5.4 (SD 1.7) drugs. Cure or completion was achieved in 66.1% (442) of patients; death occurred in 20.8% (139). Patients who received an aggressive regimen were less likely to die (crude hazard ratio [HR]: 0.62; 95% CI: 0.44,0.89), compared to those who did not receive such a regimen. This association held in analyses adjusted for comorbidities and indicators of severity (adjusted HR: 0.63; 95% CI: 0.43,0.93). Conclusions: The aggressive regimen is a robust predictor of MDR-TB treatment outcome. TB policy makers and program directors should consider this standard as they design and implement regimens for patients with drug-resistant disease. Furthermore, the aggressive regimen should be considered the standard background regimen when designing randomized trials of treatment for drug-resistant TB
Measurement of the Multi-Neutron Charged Current Differential Cross Section at Low Available Energy on Hydrocarbon
Neutron production in antineutrino interactions can lead to bias in energy
reconstruction in neutrino oscillation experiments, but these interactions have
rarely been studied. MINERvA previously studied neutron production at an
average antineutrino energy of ~3 GeV in 2016 and found deficiencies in leading
models. In this paper, the MINERvA 6 GeV average antineutrino energy data set
is shown to have similar disagreements. A measurement of the cross section for
an antineutrino to produce two or more neutrons and have low visible energy is
presented as an experiment-independent way to explore neutron production
modeling. This cross section disagrees with several leading models'
predictions. Neutron modeling techniques from nuclear physics are used to
quantify neutron detection uncertainties on this result.Comment: 25 pages, 11 figures; Added ancillary files with cross section values
as .csv Matches preprint accepted by publishe
Simultaneous measurement of muon neutrino quasielastic-like cross sections on CH, C, water, Fe, and Pb as a function of muon kinematics at MINERvA
This paper presents the first simultaneous measurement of the
quasielastic-like neutrino-nucleus cross sections on C, water, Fe, Pb and
scintillator (hydrocarbon or CH) as a function of longitudinal and transverse
muon momentum. The ratio of cross sections per nucleon between Pb and CH is
always above unity and has a characteristic shape as a function of transverse
muon momentum that evolves slowly as a function of longitudinal muon momentum.
The ratio is constant versus longitudinal momentum within uncertainties above a
longitudinal momentum of 4.5GeV/c. The cross section ratios to CH for C, water,
and Fe remain roughly constant with increasing longitudinal momentum, and the
ratios between water or C to CH do not have any significant deviation from
unity. Both the overall cross section level and the shape for Pb and Fe as a
function of transverse muon momentum are not reproduced by current neutrino
event generators. These measurements provide a direct test of nuclear effects
in quasielastic-like interactions, which are major contributors to
long-baseline neutrino oscillation data samples.Comment: 9 pages, 8 flgures, including supplemental materia
Neutrino-induced coherent production in C, CH, Fe and Pb at GeV
MINERvA has measured the -induced coherent cross section
simultaneously in hydrocarbon (CH), graphite (C), iron (Fe) and lead (Pb)
targets using neutrinos from 2 to 20 GeV. The measurements exceed the
predictions of the Rein-Sehgal and Berger-Sehgal PCAC based models at multi-GeV
energies and at produced energies and angles,
GeV and . Measurements of the cross-section ratios of
Fe and Pb relative to CH reveal the effective -scaling to increase from an
approximate scaling at few GeV to an scaling for
GeV
- …