Standards for clinical trials for treating TB.

BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice.METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached.RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff.CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice

Back to basics: hand hygiene and isolation

PURPOSE OF REVIEW: Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions. RECENT FINDINGS: Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission. SUMMARY: Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation

Staphylococcus aureus Prostatic abscess: a clinical case report and a review of the literature

BACKGROUND: Prostatic abscess is a rare complication of acute bacterial prostatitis and is most commonly caused by Enterobacteriaceae. We report on a case of prostatic abscess caused by Staphylococcus aureus and conduct a review of the literature. CASE PRESENTATIVE: We present a case of S. aureus prostatic abscess that was successfully treated with a combination of antibiotic and surgical therapy. The isolate was non–multidrug-resistant, methicillin-resistant Staphylococcus aureus and was genotyped as clonal complex 5, an emerging regional clone that is trimethoprim resistant and Panton-Valentine leukocidin positive. This current case report is the first to describe the use of clindamycin step-down therapy. A literature review identified a further 39 cases of S. aureus prostatic abscesses, of which 26 were methicillin resistant. CONCLUSION: S. aureus is an uncommon cause of prostatic abscess. Optimal management includes both antibiotic therapy and surgical drainage. Our use of clindamycin as step-down therapy was guided by its excellent prostatic penetration

Nonlinear optical response of the higher fullerene C-90 - A comparison with C-60

Degenerate four-wave-mixing measurements on C-90 in CS2 with different concentrations were performed using 70 ps laser pulses at 0.532 mu m. The dependence of the conjugate signal intensity on the incident laser power and the concentration of C-90 were investigated, By optimizing experimental parameters, the second hyperpolarizability gamma(1111) of C-90 was determined to be (1.8 +/- 0.6) X 10(-30) esu, which is approximately eight times that of the C-60 molecule measured under identical conditions. Our results are in accord with the theoretical prediction that higher fullerenes should show larger nonlinear optical responses. (C) 1997 Elsevier Science B.V

Measurement of the third-order nonlinear optical response of the metallofullerene Nd@C-82 by degenerate four wave mixing

Degenerate four-wave-mixing measurements (DFWM) on the metallofullerene Nd@C-82 in CS2 with different concentrations were performed using 70-psec laser pulses at 0.532 mu m. By optimizing experimental parameters, the second hyperpolarizability gamma(1111) of Nd@C-82 was determined to be (2.7 +/- 0.5) x 10(-30) esu, which is over an order of magnitude larger than that of the C-60 molecule measured under the identical conditions

Third-order nonlinear optical response of fullerenes as a function of the carbon cage size (C-60 to C-96) at 0.532 mu m

We report the results of our degenerate four-wave-mixing measurements (DFWM) on the fullerene series from C-60 to C-96 dissolved in CS2. The DFWM measurements were carried out using 70 ps laser pulses at the wavelength of 0.532 mu m under the optimized experimental conditions. The second hyperpolarizabilities gamma(1111) of all these fullerenes were determined to be on the order of 10(-31)-10(-30) esu, and overall they increase smoothly with the carbon cage size except for C-70 and C-78, which show anomalously larger gamma(1111) values than those of their neighboring cage sizes we investigated. The number of pi-conjugated electrons, geometrical structure, and resonance enhancement are discussed as possible factors responsible for the observed third-order optical nonlinearities of the fullerenes

Prolonged Detection of Japanese Encephalitis Virus in Urine and Whole Blood in a Returned Short-term Traveler

We describe a fatal case of Japanese encephalitis virus infection following short-term travel to Thailand. Viral RNA was detected in urine and whole blood out to 26 and 28 days, respectively, after the onset of symptoms. Live virus was isolated from a urine specimen from day 14