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

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

Recomendação de espécies arbóreas nativas, por tipo de solo, para recuperação ambiental das margens da Represa do Rio Iraí, Pinhais, PR.

A construção de reservatórios de água próximos aos grandes centros urbanos é uma realidade crescente nos dias atuais. Esse tipo de empreendimento, em geral, causa forte supressão de florestas fluviais, gerando, portanto, a necessidade de plantios logo acima da cota de máxima inundação que venham a compensar a mencionada supressão. Este trabalho tem por objetivo recomendar espécies arbóreas nativas para plantios, considerando grau de adaptabilidade dessas ao nível de hidromorfia dos solos presentes nas paisagens circunjacentes ao reservatório do rio Iraí, localizado no município de Pinhais, Paraná.Nota técnica

Recomendação de plantio com espécies arbóreas nativas, por tipo de solo, para recuperação ambiental das margens da Represa do Rio Iraí, Pinhais, PR.

bitstream/CNPF-2009-09/40503/1/com_tec149.pd

Death rates from malaria epidemics, Burundi and Ethiopia.

Death rates exceeded emergency thresholds at 4 sites during epidemics of Plasmodium falciparum malaria in Burundi (2000-2001) and in Ethiopia (2003-2004). Deaths likely from malaria ranged from 1,000 to 8,900, depending on site, and accounted for 52% to 78% of total deaths. Earlier detection of malaria and better case management are needed

Tuberculosis treatment in a refugee and migrant population: 20 years of experience on the Thai-Burmese border.

Although tuberculosis (TB) is a curable disease, it remains a major global health problem and an important cause of morbidity and mortality among vulnerable populations, including refugees and migrants

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