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

Un nouvel outil d'évaluation environnementale à l'appui des politiques de développement durable des collectivités : appropriation de l'Analyse du Cycle de Vie par les services d'assainissement

National audienceAmong the broad range of environmental assessment tools available, life cycle analysis (LCA) is shown to be the only scientific method that quantifies environmental impacts and pollution transfers. The LCA 4E tool developed for public sanitation services, has been tested in pilot cities and a research intervention was conducted in order to observe to appropriation of this new tool.In our paper, we show that the LCA 4E tool has aroused the interest of local actors but interpreting and analyzing LCA results is still difficult for non-experts.Moreover, in a context where technical choices are dominated by traditional decision criteria (regulatory, technical and economical), LCA impact on environment conceptions and strategic decision is a challenge in itself. Nevertheless, in water policy governance contexts where there is a leader actor for sustainable development and where the size of the organization helps manage new tools, LCA gives weight to environmental arguments. It also can be used to argue for certain technical choices with external partners.Parmi les nombreux outils d'évaluation environnementale qui existent, l'Analyse du cycle de vie (ACV) est présentée comme la seule méthode qui fournit une quantification scientifiquement étayée des impacts environnementaux et des transferts de pollutions. L'outil ACV 4E développé dans ce sens pour les services publics d'assainissement a fait l'objet d'un test expérimental au sein de collectivités locales pilotes et une recherche-intervention a été conduite pour observer l'appropriation de ce nouvel outil par les acteurs. C'est ce qu'aborde notre papier qui montre que si l'intérêt des acteurs pour cette nouvelle méthode d'évaluation environnementale est réel, l'interprétation et l'analyse des résultats d'une ACV restent difficiles pour des non-spécialistes. Dans un contexte par ailleurs où les choix techniques sont dominés par les critères classiques de décision (réglementaires, techniques et financiers), l'impact de l'ACV sur les conceptions de l'environnement et la prise de décision stratégique reste un défi. Néanmoins, dans les contextes de gouvernance des politiques de l'eau faisant intervenir des acteurs porteurs du développement durable et dans les collectivités locales où la taille facilite la prise en charge d'outils nouveaux, l'ACV donne plus de poids aux arguments environnementaux. Elle pourrait aussi servir à argumenter certains choix vis-à-vis des partenaires externes

Mechanisms for Lasing with Cold Atoms as the Gain Medium

We realize a laser with a cloud of cold rubidium atoms as gain medium, placed in a low-finesse cavity. Three different regimes of laser emission are observed corresponding respectively to Mollow, Raman and Four Wave Mixing mechanisms. We measure an output power of up to 300 $\mu$W and present the main properties of these different lasers in each regime

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

Genetic heterogeneity of hepatitis E virus in Darfur, Sudan, and neighboring Chad.

The within-outbreak diversity of hepatitis E virus (HEV) was studied during the outbreak of hepatitis E that occurred in Sudan in 2004. Specimens were collected from internally displaced persons living in a Sudanese refugee camp and two camps implanted in Chad. A comparison of the sequences in the ORF2 region of 23 Sudanese isolates and five HEV samples from the two Chadian camps displayed a high similarity (>99.7%) to strains belonging to Genotype 1. But four isolates collected in one of the Chadian camps were close to Genotype 2. Circulation of divergent strains argues for possible multiple sources of infection

Physical Study by Surface Characterizations of Sarin Sensor on the Basis of Chemically Functionalized Silicon Nanoribbon Field Effect Transistor

Surface characterizations of an organophosphorus (OP) gas detector based on chemically functionalized silicon nanoribbon field-effect transistor (SiNR-FET) were performed by Kelvin Probe Force Microscopy (KPFM) and ToF-SIMS, and correlated with changes in the current-voltage characteristics of the devices. KPFM measurements on FETs allow (i) to investigate the contact potential difference (CPD) distribution of the polarized device as function of the gate voltage and the exposure to OP traces and, (ii) to analyze the CPD hysteresis associated to the presence of mobile ions on the surface. The CPD measured by KPFM on the silicon nanoribbon was corrected due to side capacitance effects in order to determine the real quantitative surface potential. Comparison with macroscopic Kelvin probe (KP) experiments on larger surfaces was carried out. These two approaches were quantitatively consistent. An important increase of the CPD values (between + 399 mV and + 302 mV) was observed after the OP sensor grafting, corresponding to a decrease of the work function, and a weaker variation after exposure to OP (between - 14 mV and - 61 mV) was measured. Molecular imaging by ToF-SIMS revealed OP presence after SiNR-FET exposure. The OP molecules were essentially localized on the Si-NR confirming effectiveness and selectivity of the OP sensor. A prototype was exposed to Sarin vapors and succeeded in the detection of low vapor concentrations (40 ppm).Comment: Paper and supporting information, J. Phys. Chem. C, 201

Prevalence study of yaws in the Democratic Republic of Congo using the lot quality assurance sampling method.

BACKGROUND: Until the 1970s the prevalence of non-venereal trepanomatosis, including yaws, was greatly reduced after worldwide mass treatment. In 2005, cases were again reported in the Democratic Republic of the Congo. We carried out a survey to estimate the village-level prevalence of yaws in the region of Equator in the north of the country in order to define appropriate strategies to effectively treat the affected population. METHODOLOGY/PRINCIPAL FINDINGS: We designed a community-based survey using the Lot Quality Assurance Sampling method to classify the prevalence of active yaws in 14 groups of villages (lots). The classification into high, moderate, or low yaws prevalence corresponded to World Health Organization prevalence thresholds for identifying appropriate operational treatment strategies. Active yaws cases were defined by suggestive clinical signs and positive rapid plasma reagin and Treponema pallidum hemagglutination serological tests. The overall prevalence in the study area was 4.7% (95% confidence interval: 3.4-6.0). Two of 14 lots had high prevalence (>10%), three moderate prevalence (5-10%) and nine low prevalence (<5%.). CONCLUSIONS/SIGNIFICANCE: Although yaws is no longer a World Health Organization priority disease, the presence of yaws in a region where it was supposed to be eradicated demonstrates the importance of continued surveillance and control efforts. Yaws should remain a public health priority in countries where previously it was known to be endemic. The integration of sensitive surveillance systems together with free access to effective treatment is recommended. As a consequence of our study results, more than 16,000 people received free treatment against yaws