7,137 research outputs found
A preliminary training guide for utilizing high-altitude, color-infrared photography in compiling soil maps
Instruction for acquiring and analytically processing small-scale color-infrared photography to perform a soil resources inventory over forests of the southern U.S. is provided. Planning the project; acquiring aerial photography, materials, equipment and supplemental data; and preparing the photography for analysis are discussed. The procedures for preparing ancillary and primary component overlays are discussed. The use of correlation charts and dichotomous keys for mountain landforms, water regime, and vegetation is explained
International Environmental Law: The Impact And Implications Of Municipal Environmental Law
States universally claim access to authority and control over events and persons. States exercise power within their territories primarily to maintain and promote public order, protect their assets and wealth, and ensure the public safety. The end result of these actions is law. The operational element of law involves combinations invoking cooperation, reciprocity in treatment and behavior, and dispute management and settlement
Strengthening The Philip C. Jessup International Law Moot Court Competition
The Jessup Competition has awakened perspectives about decision making in the students of international law. It has served in the legal education of countless students, and it has even served the promotion and perhaps the development of international law itsel
Nationwide forestry applications program. Evaluation process for the ten-ecosystem study
There are no author-identified significant results in this report
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P109 The impact of tb nice guidance on resource capacity and contact screening outcomes: a retrospective, observational study within a central london tb centre
Introduction and objectives:
Recently published NICE guidance has significantly expanded the approach to adult tuberculosis (TB) contact screening by recommending tuberculin skin testing (TST) for pulmonary and laryngeal contacts only, increasing the age threshold for screening and treatment to 65 years and defining a positive TST as induration ≥5 mm, regardless of BCG vaccination status. Interferon Gamma Release Assay (IGRA) is recommended only in situations where more evidence of infection is needed.
Our institution has previously adopted an approach comprising a chest radiograph, TST and IGRA.
The aim of our study was to evaluate the impact of NICE guidance on screening outcomes and resource capacity by applying the criteria to a well-defined historic cohort of TB contacts.
Methods:
This was a retrospective, observational study carried out at a central London teaching hospital. The study population comprised 593 consecutive, adult TB contacts screened between 1/1/2008 and 31/12/2010. Data was collected through a retrospective review of TST and IGRA tests.
Results:
Of the 593 contacts screened, 358 pulmonary contacts had TST and IGRA results. 56% had a TST ≥5 mm, regardless of BCG status, qualifying them for treatment as per the new NICE guidance. Of these, 61% were IGRA negative (discordant) and may therefore include false positive diagnoses, resulting in the potential for over treatment. In those with TST 5–14 mm, discordance rises to 84%. Conversely, 6% of those with TST < 5 mm are IGRA positive representing potentially missed cases.
16% of screened individuals were contacts of extra pulmonary TB. Not screening this group would reduce the demand for outpatient appointments by 151* in our cohort. In contrast, testing contacts > 35 years would require capacity for an additional 165* appointments. Furthermore, there were 162 additional LTBI cases in comparison to previous guidance requiring an additional 648* appointments. 72% of this group were IGRA negative.
(*Approximate)
Conclusions:
Our results show the revised guidance will require increased resource capacity largely due to more patients being classified as having latent TB. In addition to workforce planning to meet these demands, further debate is needed to decide if this new approach truly reduces the incidence of active TB or results in unnecessary treatment
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