Quality of care for patients evaluated for tuberculosis in the context of Xpert MTB/RIF scale-up.

RATIONALE: Many high-burden countries are scaling-up Xpert MTB/RIF using a hub-and-spoke model. We evaluated the quality of care for patients undergoing TB evaluation at microscopy centers (spokes) linked to Xpert testing sites (hubs) in Uganda. OBJECTIVES: To characterize the extent to which patients were receiving care in accordance with international and national guidelines. METHODS: We conducted a prospective cohort study of all adults with presumptive pulmonary TB at 24 health centers linked to Xpert testing sites. Health center staff photographed TB registers, and uploaded photos to a secure server bi-weekly. We assessed the proportion of patients (1) initiating testing; (2) completing testing; and (3) treated for confirmed TB within 14 days. MEASUREMENTS AND MAIN RESULTS: Between January to December 2017, 6744 patients underwent evaluation for pulmonary TB. Only 1316 patients had sputum referred for Xpert testing, including 1075/3229 (33.3%) people living with HIV and 241/3515 (6.9%) without HIV. Of 119 patients confirmed to have TB by Xpert testing, 44 (36%) did not initiate treatment. There were significant losses along the entire diagnostic cascade of care, with only 5330/6744 (79.0%) patients having samples referred for sputum-based testing, 2978/5330 (55.9%) patients completing recommended testing if referred, and 313/418 (74.9%) patients initiating treatment within 14 days if confirmed to have TB. CONCLUSIONS: Although coverage of Xpert testing services across Uganda is high, the quality of care delivered to patients undergoing TB evaluation remains poor. Further research is needed to identify health system interventions to facilitate uptake of Xpert testing and high-quality care

A guide to in vivo optogenetic applications for cerebellar studies

The mammalian cerebellum consists of a superficial cortex and centrally located output nuclei, which together with brainstem nuclei are organized in a modular fashion. Regardless of the function, these cerebellar modules consist of the same cell types, and their connectivity has been unraveled to some detail using electrical stimulation experiments. To unravel the highest level of detail, cell-specific stimulation experiments are warranted, which cannot be accomplished using electrical stimulation. To reach this unprecedented level of specificity, optogenetic applications are now being implemented in cerebellar studies. Due to the extensive knowledge about cell-specific markers in both the cerebellar cortex and the cerebellar nuclei, optogenetics can be applied cell specifically. Ideally the anatomical and electrophysiological characteristics of the cerebellum can be utilized for designing future optogenetic studies. In this chapter we review the opportunities and pitfalls for optogenetic studies in the cerebellum. We provide insights into the technical issues at hand and which solutions are currently available