Latent tuberculosis infection screening of adult close contacts in London: a cost-utility analysis

Background: The National Institute for Health and Care Excellence (NICE) guidelines in 2016 recommend tuberculin skin test (TST) at a 5 mm induration size cut-off for latent tuberculosis infection (LTBI) screening of adult close contacts of active tuberculosis (TB) cases. An alternative would be to use an interferon-gamma release assay (IGRA) which has a higher specificity, such as the QuantiFERON-TB Gold in Tube (QFT-GIT) or T-SPOT.TB (T-SPOT). We aimed to evaluate the cost-effectiveness of the screening and treatment of LTBI in adult close contacts with various combinations of these tests in a representative London cohort. Methods: Clinical data of adult close contacts of pulmonary TB cases who were recommended to receive TST and IGRA in a TB clinic in London between 2008 and 2010 were retrospectively reviewed. A Markov decision analytic model, using an NHS perspective and lifetime horizon, was used to compare costs and quality-adjusted life-years (QALYs) associated with 7 screening strategies followed by chemoprophylaxis: TST alone, IGRA (QFT-GIT or T-SPOT) alone, TST positive followed by IGRA, and TST negative followed by IGRA. Future costs and QALYs were discounted at 3.5% per year. Results: 381 asymptomatic close contacts aged 18 to 65 years were included in this study. The mean age was 35.2 years and the majority (75.3%) were BCG vaccinated. In the base-case analysis, QFT-GIT was the most cost-effective strategy with £6876 per QALY gained, compared to TST positive followed by QFT-GIT strategy. QFT-GIT alone averted 1.6 TB cases per 1000 contacts compared to TST positive followed by QFT-GIT. Conclusion: Of the considered testing strategies, the QFT-GIT alone is preferable for LTBI screening in adult close contacts of pulmonary TB cases in London

Automatic Computation of Cross Sections in HEP

For the study of reactions in High Energy Physics (HEP) automatic computation systems have been developed and are widely used nowadays. GRACE is one of such systems and it has achieved much success in analyzing experimental data. Since we deal with the cross section whose value can be given by calculating hundreds of Feynman diagrams, we manage the large scale calculation, so that effective symbolic manipulation, the treat of singularity in the numerical integration are required. The talk will describe the software design of GRACE system and computational techniques in the GRACE.Comment: 6 pages, Latex, ICCP

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

GRIDKIT: Pluggable overlay networks for Grid computing

A `second generation' approach to the provision of Grid middleware is now emerging which is built on service-oriented architecture and web services standards and technologies. However, advanced Grid applications have significant demands that are not addressed by present-day web services platforms. As one prime example, current platforms do not support the rich diversity of communication `interaction types' that are demanded by advanced applications (e.g. publish-subscribe, media streaming, peer-to-peer interaction). In the paper we describe the Gridkit middleware which augments the basic service-oriented architecture to address this particular deficiency. We particularly focus on the communications infrastructure support required to support multiple interaction types in a unified, principled and extensible manner-which we present in terms of the novel concept of pluggable overlay networks

Engaging with civil society to improve access to LTBI screening for new migrants in England: a qualitative study

SETTING: The latent tuberculous infection (LTBI) programme in England, UK, offers testing and treatment to new migrants from high tuberculosis incidence countries. However, the rates of LTBI testing, treatment acceptance and completion are suboptimal and appropriate access should be improved. OBJECTIVE: To gain insight from the community, community-based organisations (CBOs) and public sector stakeholders on interventions that facilitate collaboration to improve health care outreach and delivery. DESIGN: Three stakeholder meetings and five focus group discussions were held using thematic analysis to identify themes arising from participants' perspectives. RESULTS: Four overarching themes emerged from the discussions. These were related to capacity of service providers, collaboration between stakeholders, migrant cultures and trust between migrants and service providers, and highlighted the complementary skill sets that different sectors bring to the collaboration, as well as the barriers that need to be surmounted. Stigma could be reduced by making LTBI testing routine. Community members could act as champions of health promotion to raise awareness on LTBI testing, and provide a bridge between communities and primary care services. CONCLUSION: Public service providers, community members and CBOs are willing to collaborate to support primary care delivery of testing for LTBI and other communicable and non-communicable diseases. Policy and commissioning support are needed to facilitate this collaboration

Implications of the HERA Events for the R-Parity Breaking SUSY Signals at Tevatron

The favoured R-parity violating SUSY scenarios for the anomalous HERA events correspond to top and charm squark production via the $\lambda'_{131}$ and $\lambda'_{121}$ couplings. In both cases the corresponding electronic branching fractions of the squarks are expected to be $\ll 1$. Consequently the canonical leptoquark signature is incapable of probing these scenarios at the Tevatron collider over most of the MSSM parameter space. We suggest alternative signatures for probing them at Tevatron, which seem to be viable over the entire range of MSSM parameters.Comment: 20 pages Latex file with 4 ps files containing 4 figure