Global burden of drug-resistant tuberculosis in children: a mathematical modelling study

Background: After infection with Mycobacterium tuberculosis, children are at an increased risk of progression to tuberculosis disease; a condition that can be challenging to diagnose. New estimation approaches for children have highlighted the gap between incidence and notifications of M tuberculosis, and suggest there are more cases of isoniazid-resistant and multidrug-resistant (MDR) disease than are identified. No work has yet quantified the burden of drug-resistant infection, or accounted for other types of drug resistance or sampling uncertainty. Methods: We combined a mathematical model of tuberculosis in children with an analysis of drug-resistance patterns to produce country-level, regional, and global estimates of drug-resistant infection and disease. We determined drug resistance using data from the Global Project on Antituberculosis Drug Resistance Surveillance at WHO, from surveys and surveillance reported between 1988 and 2014. We combined 1000 sampled proportions for each country from a Bayesian approach with 10 000 sampled country estimates of tuberculosis disease incidence and M tuberculosis infection prevalence. We estimated the proportions of tuberculosis cases at a country level with isoniazid monoresistance, rifampicin monoresistance, multidrug resistance (MDR), fluoroquinolone-resistant multidrug resistance, second-line injectable-resistant multidrug resistance, and extensive multidrug resistance with resistance to both a fluoroquinolone and a second-line injectable (XDR). Findings: We estimated that 850 000 children developed tuberculosis in 2014; 58 000 with isoniazid-monoresistant tuberculosis, 25 000 with MDR tuberculosis, and 1200 with XDR tuberculosis. We estimate 67 million children are infected with M tuberculosis; 5 million with isoniazid monoresistance, 2 million with MDR, and 100 000 with XDR. Africa and southeast Asia have the highest numbers of children with tuberculosis, but the WHO Eastern Mediterranean region, European region, and Western Pacific region also contribute substantially to the burden of drug-resistant tuberculosis because of their much higher proportions of resistance. Interpretation: Far more drug-resistant tuberculosis occurs in children than is diagnosed, and there is a large pool of drug-resistant infection. This finding has implications for approaches to empirical treatment and preventive therapy in some regions of the world

Sarcoptic mange of pigs

THIS parasitic disease appears to be much more common than is usually recognised; for, while severe cases with chronic skin lesions are readily seen, light infestations, especially on coloured pigs often go unnoticed. When it is realised that even lightly infested pigs require twice as much feed to make one pound gain in live weight as do uninfested pigs, then early recognition and treatment of the disease becomes an obvious economical necessity

‘I think the school listened…and they were flexible enough to act on it’. Emotionally based school avoidance: an exploration of factors contributing to positive outcomes for secondary school children

School absence affects children's social, emotional and academic development, reduces social opportunities, limits employment prospects and can result in/foreshadow poor adult mental health. Tackling this problem early is crucial for improving children’s future opportunities. UK statistics indicate an incremental increase in persistent absences, exacerbated following COVID-19. The UK government has recently highlighted that working to improve attendance is ‘everyone’s business’. Educational Psychologists, who work with children, families and schools, are well placed to support children experiencing emotionally based school avoidance (EBSA). This study explores perceived factors that helped two secondary-age school students to reintegrate into school, following EBSA. It seeks to understand their cases within a local context, with a case study design, to build ‘practice-based’ evidence that can support the development of an EBSA pathway for the Local Authority, as well as contribute to a larger set of qualitative data on what is a highly relevant current topic. A qualitative methodological approach has been employed. Data was collected using semi-structured interviews, to capture the perceptions of children and young people (CYP), parents, school staff and professionals regarding the factors that contributed to CYP’s reintegration into school. Reflexive Thematic Analysis indicated that trusting relationships promoted CYP’s sense of safety in school, supporting their reintegration. Additional themes identified were ‘the importance of a positive, supportive and inclusive school ethos’ and ‘the key role of a collaborative supportive network around the child’. CYP’s individual qualities and intrinsic motivation were also found to contribute to their reintegration in school, while a person-centred approach promoted their sense of competence and autonomy. These results support the idea that EBSA is a complex, multi-faceted phenomenon, which can be tackled if various factors come together to support reintegration. The findings raise implications [and lessons] for schools and professionals, for policy makers and, in particular, for Educational Psychologists

Debate: The development of a new discipline— public service operations management

This piece aims to outline the development of a discipline – Public Service Operations Management and will argue the importance of developing an understanding between public management and operations management literature and theory This is reflected through the recent publication of an edited companion which aspires to explore and define bodies of knowledge related to Public Service Operations Managemen

Retooling existing tuberculosis drugs for children.

Please help populate SUNScholar with the full text of SU research output. Also - should you need this item urgently, please send us the details and we will try to get hold of the full text as quick possible. E-mail to [email protected]. Thank you.Journal Articles (subsidised)Geneeskunde en GesondheidswetenskappePediatrie En Kindergesondhei

The association of children's distress during venepuncture with parent and staff behaviours

Venepuncture and other needle-related procedures can distress children and have a lasting negative impact. Adults' behaviour during these procedures may affect children's reactions. However, the literature is contradictory and rarely considers verbal and non-verbal behaviour together. This study therefore examined the effect of adults' verbal and non-verbal behaviour on children's distress during venepuncture. Participants comprised 51 child and carer dyads and 10 staff members. Child anxiety was measured before the procedure. The procedure was recorded. The resulting audio-visual data were coded using the Child-Adult Medical Procedure Interaction Scale-Revised. Correlation analysis identified variables that were significantly associated with child distress: child anxiety, carer distress-promoting behaviour, staff distress-promoting behaviour and intimate distance. These were included in a path diagram of child distress. Exploration of the diagram identified that children's anxiety was mostly strongly associated with children's distress during venepuncture. Staff and carer behaviour did not increase children's distress. The results suggest interventions to reduce children's distress during venepuncture may be more effective if they focus on reducing children's anxiety beforehand

Acceptability of orodispersible films for delivery of medicines to infants and preschool children

Orodispersible films (ODFs) possess potential to facilitate oral drug delivery to children; however, documentation of their acceptability in this age group is lacking. This study is the first to explore the initial perceptions, acceptability and ease of use of ODFs for infants and preschool children, and their caregivers through observed administration of the type of dosage form. Placebo ODFs were administered to children stratified into aged 6 to 12 months, 1 year, 2 years, 3 years, 4 years and 5 years old and into those with an acute illness or long-term stable condition in hospital setting. Acceptability of the dosage form and end-user views were assessed by (a) direct observation of administration, (b) questionnaires to caregivers and nurses, and (c) age-adapted questionnaires for children aged 3 years and over. The majority of children (78%) aged 3 years and over gave the ODF a positive rating both on verbal and non-verbal scales. Despite little prior experience, 78% of caregivers expressed positive opinion about ODFs before administration. After the ODFs were taken, 79% of infant caregivers and 86% caregivers of preschool children positively rated their child’s acceptance of the ODF. The intraclass correlation coefficient value was 0.92 showing good agreement between ratings of caregivers and nurses. ODFs showed a high degree of acceptability among young children and their caregivers. If drug loading permits, pharmaceutical companies should consider developing pediatric medicines in this format. The methodology described here is useful in assessing the acceptability of active ODF preparations and other dosage forms to children

Efficient compact modelling of UTC-photodiode towards terahertz communication system design

Monolithic optoelectronic integrated circuits, OEICs are seen as key enabling technologies to minimal power loss criteria. Monolithic OEICs combine, on the same die, cutting-edge optical devices and high speed III-V electronics able to generate terahertz signal targeting beyond-5G networks. Computationally efficient compact models compatible with existing software tool and design flow are essential for timely and cost-effective OEIC achievement. The analog nature of photonic devices wholly justifies the use of methodologies alike the ones employed in electronic design automation, through implementation of accurate (and SPICE-compatible) compact models. This multidisciplinary work, describes an efficient compact model for Uni-Traveling Carrier photodiodes (UTC PD) which is a key component for OEICs. Its equations feature the UTC PD electronic transport and frequency response along with its photocurrent under applied optical power. It also dynamically takes into account the device junction temperature, accounting for the self-heating effect. Excellent agreement between model and measurements as well as model scalability (several geometries have been validated) has been achieved that marks the first demonstration of a multi-physics, computationally efficient and versatile compact model for UTC-PDs

Peripheries and praxis: the effect of rubric co-construction on student perceptions of their learning

The construction of assessment rubrics is often educator-centric as lecturers work in isolation to compose grading tools. While there is a pedagogical goal to construct instruments that align with learning outcomes and guide the assessment of students’ learning, students are often at the periphery of this process. In many higher education institutions, students are accustomed to receiving assessment feedback but they are not, typically, active participants in the feedback cycle. Increasingly, institutions are seeking evidence of greater student engagement in their tertiary learning experience. Accordingly, academics seek to innovate practice and enhance curricula by creating more opportunities for student involvement, thus creating a shared understanding of it and associated assessment tasks. Responding to a gap in rubric construction practice, this paper discusses an Office for Learning and Teaching Innovation and Development Grant research project where students moved from being rubric users to being central participants in collaborative design. Drawing on data collected from a team of rubric co-constructors from one Sydney university campus – first year students and an academic in a creative non-fiction writing subject – we set out to answer the following question: What effect does the co-construction and use of rubrics have on students’ perceptions of their learning

High Speed Photodetectors

High speed photodetectors are important for a number of applications. This work is about accurate design of uni-travelling carrier photodetectors. In particular, integrated devices with antenna for operating frequencies above 100 GHz