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

Exploring the Time to Intervene with a Reactive Mass Vaccination Campaign in Measles Epidemics.

The current WHO policy during measles outbreaks focuses on case management rather than reactive vaccination campaigns in urban areas of resource-poor countries having low vaccine coverage. Vaccination campaigns may be costly, or not timely enough to impact significantly on morbidity and mortality. We explored the time available for intervention during two recent epidemics. Our analysis suggests that the spread of measles in African urban settings may not be as fast as expected. Examining measles epidemic spread in Kinshasa (DRC), and Niamey (Niger) reveals a progression of smaller epidemics. Intervening with a mass campaign or in areas where cases have not yet been reported could slow the epidemic spread. The results of this preliminary analysis illustrate the importance of revisiting outbreak response plans

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

Reducing wasting in young children with preventive supplementation: a cohort study in Niger

OBJECTIVE: To compare the incidence of wasting, stunting, and mortality among children aged 6 to 36 months who are receiving preventive supplementation with either ready-to-use supplementary foods (RUSFs) or ready-to-use therapeutic foods (RUTFs). SUBJECTS AND METHODS: Children aged 6 to 36 months in 12 villages of Maradi, Niger, (n = 1645) received a monthly distribution of RUSFs (247 kcal [3 spoons] per day) for 6 months or RUTFs (500-kcal sachet per day) for 4 months. We compared the incidence of wasting, stunting, and mortality among children who received preventive supplementation with RUSFs versus RUTFs. RESULTS: The effectiveness of RUSF supplementation depended on receipt of a previous preventive intervention. In villages in which a preventive supplementation program was previously implemented, the RUSF strategy was associated with a 46% (95% confidence interval [CI]: 6%-69%) and 59% (95% CI: 17%-80%) reduction in wasting and severe wasting, respectively. In contrast, in villages in which the previous intervention was not implemented, we found no difference in the incidence of wasting or severe wasting according to type of supplementation. Compared with the RUTF strategy, the RUSF strategy was associated with a 19% (95% CI: 0%-34%) reduction in stunting overall. CONCLUSION: We found that the relative performance of a 6-month RUSF supplementation strategy versus a 4-month RUTF strategy varied with receipt of a previous nutritional intervention. Contextual factors will continue to be important in determining the dose and duration of supplementation that will be most effective, acceptable, and sustainable for a given setting

Theoretical tools for atom laser beam propagation

We present a theoretical model for the propagation of non self-interacting atom laser beams. We start from a general propagation integral equation, and we use the same approximations as in photon optics to derive tools to calculate the atom laser beam propagation. We discuss the approximations that allow to reduce the general equation whether to a Fresnel-Kirchhoff integral calculated by using the stationary phase method, or to the eikonal. Within the paraxial approximation, we also introduce the ABCD matrices formalism and the beam quality factor. As an example, we apply these tools to analyse the recent experiment by Riou et al. [Phys. Rev. Lett. 96, 070404 (2006)]

Interface Dipole : Effects on Threshold Voltage and Mobility for both Amorphous and Poly-crystalline Organic Field Effect Transistors

We report a detailed comparison on the role of a self-assembled monolayer (SAM) of dipolar molecules on the threshold voltage and charge carrier mobility of organic field-effect transistor (OFET) made of both amorphous and polycrystalline organic semiconductors. We show that the same relationship between the threshold voltage and the dipole-induced charges in the SAM holds when both types of devices are fabricated on strictly identical base substrates. Charge carrier mobilities, almost constant for amorphous OFET, are not affected by the dipole in the SAMs, while for polycrystalline OFET (pentacene) the large variation of charge carrier mobilities is related to change in the organic film structure (mostly grain size).Comment: Full paper and supporting informatio

The dynamics of measles in sub-Saharan Africa.

Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel. On the basis of measles dynamics for industrialized countries, high birth rate regions should experience regular annual epidemics. Here, however, we show that measles epidemics in Niger are highly episodic, particularly in the capital Niamey. Models demonstrate that this variability arises from powerful seasonality in transmission-generating high amplitude epidemics-within the chaotic domain of deterministic dynamics. In practice, this leads to frequent stochastic fadeouts, interspersed with irregular, large epidemics. A metapopulation model illustrates how increased vaccine coverage, but still below the local elimination threshold, could lead to increasingly variable major outbreaks in highly seasonally forced contexts. Such erratic dynamics emphasize the importance both of control strategies that address build-up of susceptible individuals and efforts to mitigate the impact of large outbreaks when they occur

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

Electron transport through rectifying self-assembled monolayer diodes on silicon: Fermi level pinning at the molecule-metal interface

We report the synthesis and characterization of molecular rectifying diodes on silicon using sequential grafting of self-assembled monolayers of alkyl chains bearing a pi group at their outer end (Si/sigma-pi/metal junctions). We investigate the structure-performance relationships of these molecular devices and we examine to what extent the nature of the pi end-group (change in the energy position of their molecular orbitals) drives the properties of these molecular diodes. For all the pi-groups investigated here, we observe rectification behavior. These results extend our preliminary work using phenyl and thiophene groups (S. Lenfant et al., Nano Letters 3, 741 (2003)).The experimental current-voltage curves are analyzed with a simple analytical model, from which we extract the energy position of the molecular orbital of the pi-group in resonance with the Fermi energy of the electrodes. We report the experimental studies of the band lineup in these silicon/alkyl-pi conjugated molecule/metal junctions. We conclude that Fermi level pinning at the pi-group/metal interface is mainly responsible for the observed absence of dependence of the rectification effect on the nature of the pi-groups, even though they were chosen to have significant variations in their electronic molecular orbitalsComment: To be published in J. Phys. Chem.

Negative Differential Resistance, Memory and Reconfigurable Logic Functions based on Monolayer Devices derived from Gold Nanoparticles Functionalized with Electro-polymerizable Thiophene-EDOT Units

We report on hybrid memristive devices made of a network of gold nanoparticles (10 nm diameter) functionalized by tailored 3,4(ethylenedioxy)thiophene (TEDOT) molecules, deposited between two planar electrodes with nanometer and micrometer gaps (100 nm to 10 um apart), and electropolymerized in situ to form a monolayer film of conjugated polymer with embedded gold nanoparticles (AuNPs). Electrical properties of these films exhibit two interesting behaviors: (i) a NDR (negative differential resistance) behavior with a peak/valley ratio up to 17, and (ii) a memory behavior with an ON/OFF current ratio of about 1E3 to 1E4. A careful study of the switching dynamics and programming voltage window is conducted demonstrating a non-volatile memory. The data retention of the ON and OFF states is stable (tested up to 24h), well controlled by the voltage and preserved when repeating the switching cycles (800 in this study). We demonstrate reconfigurable Boolean functions in multiterminal connected NP molecule devices.Comment: Full manuscript, figures and supporting information, J. Phys. Chem. C, on line, asap (2017