Mortality predictor score in hospitalised patients HIV-associated TB in Africa dataset

This dataset contains details of hospital patients with HIV-associated tuberculosis in sub-Saharan Africa from the STAMP clinical trial. It was generated to derive predictor score for mortality including urine lipoarabinomannan detection. Variables include: age, sex, weight, living status, number of day in follow-up, ART treatment, WHO danger sign, Haemoglobin level, ability to walk, and urine LAM positivity

Detection of lipoarabinomannan (LAM) in urine is indicative of disseminated TB with renal involvement in patients living with HIV and advanced immunodeficiency: evidence and implications.

TB is the leading cause of HIV/AIDS-related deaths globally. New diagnostic tools are urgently needed to avert deaths from undiagnosed HIV-associated TB. Although simple assays that detect lipoarabinomannan (LAM) in urine have been commercially available for years, their specific role and utility were initially misunderstood, such that they have been slower to emerge from the diagnostics pipeline than otherwise might have been expected. In this article, we review and explain how urine-LAM assays should be understood as diagnostics for disseminated TB in HIV-positive patients with advanced immunodeficiency, in whom haematogenous TB dissemination to the kidneys serves as the primary mechanism by which LAM enters the urine. These insights are critical for the appropriate design of studies to evaluate these assays and to understand how they might be most usefully implemented. This understanding also supports the 2015 WHO recommendations on the restricted use of these assays in sick HIV-positive patients with advanced immunodeficiency

Xpert MTB/RIF - why the lack of morbidity and mortality impact in intervention trials?

: Compared with smear microscopy, the Xpert MTB/RIF assay (Xpert), with superior accuracy and capacity to diagnose rifampicin resistance, has advanced TB diagnostic capability. However, recent trials of Xpert impact have not demonstrated reductions in patient morbidity and mortality. We conducted a narrative review of Xpert impact trials to summarize which patient-relevant outcomes Xpert has improved and explore reasons for no observed morbidity or mortality reductions. We searched PubMed, Google Scholar, Cochrane Library and Embase and identified eight trials meeting inclusion criteria: three individually randomized, three cluster-randomized, and two pre-post trials. In six trials Xpert increased diagnostic yield of bacteriologically-confirmed TB from sputa and in four trials Xpert shortened time to TB treatment. However, all-cause mortality was similar between arms in all six trials reporting this outcome, and the only trial to assess Xpert impact on morbidity reported no impact. Trial characteristics that might explain lack of observed impact on morbidity and mortality include: higher rates of empiric TB treatment in microscopy compared with Xpert arms, enrollment of study populations not comprised exclusively of populations most likely to benefit from Xpert, and health system weaknesses. So far as equipoise exists, future trials that address past limitations are needed to inform Xpert use in resource-limited settings.<br/

Using Beatboxing for Creative Rehabilitation After Laryngectomy:Experiences From a Public Engagement Project

Laryngectomy is the surgical removal of the larynx (voice box), usually performed in patients with advanced stages of throat cancer. The psychosocial impact of losing the voice is significant, affecting a person’s professional and social life in a devastating way, and a proportion of this patient group subsequently must overcome depression (22–30%) and social isolation (40%). The profound changes to anatomical structures involved in voicing and articulation, as a result of surgery, radiotherapy or chemotherapy (separately or in combination with one another), introduce challenges faced in speech rehabilitation and voice production that complicate social reintegration and quality of life. After laryngectomy, breathing, voicing, articulation and tongue movement are major components in restoring communication. Regular exercise of the chest, neck and oropharyngeal muscles, in particular, is important in controlling these components and keeping the involved structures supple. It is, however, a difficult task for a speech therapist to keep the patient engaged and motivated to practice these exercises. We have adopted a multidisciplinary approach to explore the use of basic beatboxing techniques to create a wide variety of exercises that are seen as fun and interactive and that maximize the use of the structures important in alaryngeal phonation. We herein report on our empirical work in developing patients’ skills, particularly relating to voiced and unvoiced consonants to improve intelligibility. In collaboration with a professional beatboxing performer, we produced instructional online video materials to support patients working on their own and/or with support from speech therapists. Although the present paper is focused predominantly on introducing the structure of the conducted workshops, the rationale for their design and the final public engagement performance, we also include feedback from participants to commence the critical discourse about whether this type of activity could lead to systematic underlying research and robustly assessed interventions in the future. Based on this exploratory work, we conclude that the innovative approach that we employed was found to be engaging, useful, informative and motivating. We conclude by offering our views regarding the limitations of our work and the implications for future empirical research

World TB Day 2018: The Challenge of Drug Resistant Tuberculosis.

On 24th March, the world commemorates the day in 1882 when Dr Robert Koch announced his discovery of Mycobacterium tuberculosis (MTB). Over 130 years later, tuberculosis (TB) continues to affect individuals, communities, and entire health systems and economies. Koch unsuccessfully tried to 'cure' TB, and despite major advances in other areas of medicine, control of TB remains elusive- in 2016 TB was the leading infectious cause of death. The STOP TB partnership and World Health Organization (WHO) have announced their theme for World TB Day 2018 "Wanted: Leaders for a TB-Free World. You can make history. End TB." This theme recognizes that TB is much larger than any one person, institute or discipline of research, and provides an opportunity for us to reflect on the major challenges and consider how we, as a scientific community, can work together and take the lead to address the global crisis of drug-resistant TB (DR-TB)

The Geometry of PSR B0031-07

PSR B0031-07 is well known to exhibit three different modes of drifting sub-pulses (mode A, B and C). It has recently been shown that in a multifrequency observation, consisting of 2700 pulses, all driftmodes were visible at low frequencies, while at 4.85 GHz only mode-A drift or non-drifting emission was detected. This suggests that modes A and B are emitted in sub-beams, rotating at a fixed distance from the magnetic axis, with the mode-B sub-beams being closer to the magnetic axis than the mode-A sub-beams. Diffuse emission between the sub-beams can account for the non-drifting emission. Using the results of an analysis of simultaneous multifrequency observations of PSR B0031-07, we set out to construct a geometrical model that includes emission from both sub-beams and diffuse emission and describes the regions of the radio emission of PSR B0031-07 at each emission frequency for driftmodes A and B. Based on the vertical spacing between driftbands, we have determined the driftmode of each sequence of drift. To restrict the model, we calculated average polarisation and intensity characteristics for each driftmode and at each frequency. The model reproduces the observed polarisation and intensity characteristics, suggesting that diffuse emission plays an important role in the emission properties of PSR B0031-07. The model further suggests that the emission heights of this pulsar range from a few kilometers to a little over 10 kilometers above the pulsar surface. We also find that the relationships between height and frequency of emission that follow from curvature radiation and from plasma-frequency emission could not be used to reproduce the observed frequency dependence of the width of the average intensity profiles.Comment: 15 pages, 9 figures, 8 tables, accepted for publication in A&

Numerical Solutions of 2-D Steady Incompressible Driven Cavity Flow at High Reynolds Numbers

Numerical calculations of the 2-D steady incompressible driven cavity flow are presented. The Navier-Stokes equations in streamfunction and vorticity formulation are solved numerically using a fine uniform grid mesh of 601x601. The steady driven cavity solutions are computed for Re<21,000 with a maximum absolute residuals of the governing equations that were less than 10-10. A new quaternary vortex at the bottom left corner and a new tertiary vortex at the top left corner of the cavity are observed in the flow field as the Reynolds number increases. Detailed results are presented and comparisons are made with benchmark solutions found in the literature

How primary care can contribute to good mental health in adults.

The need for support for good mental health is enormous. General support for good mental health is needed for 100% of the population, and at all stages of life, from early childhood to end of life. Focused support is needed for the 17.6% of adults who have a mental disorder at any time, including those who also have a mental health problem amongst the 30% who report having a long-term condition of some kind. All sectors of society and all parts of the NHS need to play their part. Primary care cannot do this on its own. This paper describes how primary care practitioners can help stimulate such a grand alliance for health, by operating at four different levels - as individual practitioners, as organisations, as geographic clusters of organisations and as policy-makers