The number of privately treated tuberculosis cases in India: an estimation from drug sales data

Background Understanding the amount of tuberculosis managed by the private sector in India is crucial to understanding the true burden of the disease in the country, and thus globally. In the absence of quality surveillance data on privately treated patients, commercial drug sales data offer an empirical foundation for disease burden estimation. Methods We used a large, nationally representative commercial dataset on sales of 189 anti-tuberculosis products available in India to calculate the amount of anti-tuberculosis treatment in the private sector in 2013–14. We corrected estimates using validation studies that audited prescriptions against tuberculosis diagnosis, and estimated uncertainty using Monte Carlo simulation. To address implications for numbers of patients with tuberculosis, we explored varying assumptions for average duration of tuberculosis treatment and accuracy of private diagnosis. Findings There were 17·793 million patient-months (95% credible interval 16·709 million to 19·841 million) of anti-tuberculosis treatment in the private sector in 2014, twice as many as the public sector. If 40–60% of private-sector tuberculosis diagnoses are correct, and if private-sector tuberculosis treatment lasts on average 2–6 months, this implies that 1·19–5·34 million tuberculosis cases were treated in the private sector in 2014 alone. The midpoint of these ranges yields an estimate of 2·2 million cases, two to three times higher than currently assumed. Interpretation India's private sector is treating an enormous number of patients for tuberculosis, appreciably higher than has been previously recognised. Accordingly, there is a re-doubled need to address this burden and to strengthen surveillance. Tuberculosis burden estimates in India and worldwide require revision

Patient safety and estimation of renal function in patients prescribed new oral anticoagulants for stroke prevention in atrial fibrillation

OBJECTIVE: In clinical trials of dabigatran and rivaroxaban for stroke prevention in atrial fibrillation (AF), drug eligibility and dosing were determined using the Cockcroft-Gault equation to estimate creatine clearance as a measure of renal function. This cross-sectional study aimed to compare whether using estimated glomerular filtration rate (eGFR) by the widely available and widely used Modified Diet in Renal Disease (MDRD) equation would alter prescribing or dosing of the renally excreted new oral anticoagulants. PARTICIPANTS: Of 4712 patients with known AF within a general practitioner-registered population of 930 079 in east London, data were available enabling renal function to be calculated by both Cockcroft-Gault and MDRD methods in 4120 (87.4%). RESULTS: Of 4120 patients, 2706 were <80 years and 1414 were ≥80 years of age. Among those ≥80 years, 14.9% were ineligible for dabigatran according to Cockcroft-Gault equation but would have been judged eligible applying MDRD method. For those <80 years, 0.8% would have been incorrectly judged eligible for dabigatran and 5.3% would have received too high a dose. For rivaroxaban, 0.3% would have been incorrectly judged eligible for treatment and 13.5% would have received too high a dose. CONCLUSIONS: Were the MDRD-derived eGFR to be used instead of Cockcroft-Gault in prescribing these new agents, many elderly patients with AF would either incorrectly become eligible for them or would receive too high a dose. Safety has not been established using the MDRD equation, a concern since the risk of major bleeding would be increased in patients with unsuspected renal impairment. Given the potentially widespread use of these agents, particularly in primary care, regulatory authorities and drug companies should alert UK doctors of the need to use the Cockcroft-Gault formula to calculate eligibility for and dosing of the new oral anticoagulants in elderly patients with AF and not rely on the MDRD-derived eGFR

Universal scaling properties of extremal cohesive holographic phases

We show that strongly-coupled, translation-invariant holographic IR phases at finite density can be classified according to the scaling behaviour of the metric, the electric potential and the electric flux introducing four critical exponents, independently of the details of the setup. Solutions fall into two classes, depending on whether they break relativistic symmetry or not. The critical exponents determine key properties of these phases, like thermodynamic stability, the (ir)relevant deformations around them, the low-frequency scaling of the optical conductivity and the nature of the spectrum for electric perturbations. We also study the scaling behaviour of the electric flux through bulk minimal surfaces using the Hartnoll-Radicevic order parameter, and characterize the deviation from the Ryu-Takayanagi prescription in terms of the critical exponents.Comment: v4: corrected a typo in eqn (3.29), now (3.28). Conclusions unchange

On multiplicity correlations in the STAR data

The STAR data on the multiplicity correlations between narrow psudorapidity bins in the pp and AuAu collisions are discussed. The PYTHIA 8.145 generator is used for the pp data, and a naive superposition model is presented for the AuAu data. It is shown that the PYTHIA generator with default parameter values describes the pp data reasonably well, whereas the superposition model fails to reproduce the centrality dependence seen in the data. Some possible reasons for this failure and a comparison with other models are presented.Comment: 8 pages, 3 figure

Evaluation and export of Pseudacteon decapitating flies (Phoridae:Diptera) collected in the Jaguariuna area for fire ant biocontrol in the USA.

Fire ant decapitating flies were studied in and around the Embrapa-National Research Center for Environmental Monitoring and Impact Assessment, in Jaguariuna, State of Sao Paulo, Brazil. The objective was to evaluate and select several species for exporting to the United States as biocontrol agents. Eight species were collected during this study (January-June, 1996): Pseudacteon convexicauda, P. curvatus, P. litoralis, P. obtusus, P. pradei, P. solenopsidis, P. tricuspis and P. wasmanni. Seven species (all except P. convexicauda) were reared from eggs to adults. All seven species had the unusual habit of pupating inside the head capsule of their host. No suitable morphological characters were found to discriminate pupae of the different species. Pupae of different sexes were also indistinguishable except that females consistently emerged from larger hosts than males. The males of P. tricuspis readily mated with females while they were ovipositing in fire ant workers, but it was not possible to determine when and were other species of decapitating flies mated. Consequently, it was only possible to develop techniques for rearing P. tricuspis. Two species (P.tricuspis and p. litoralis) were sufficiently abundant to be exported to the USDA-ARS from Brazilian Quarantine Laboratory for specificity testing. After a period in USDA quarantine facilities both species received permission to be released and tested under field conditions in the USA

Aspectos técnicos e econômicos da terminação de cordeiros a pasto e em confinamento.

SISTEMAS DE TERMINAÇÃO DE CORDEIROS; FATORES INERENTES AO CORDEIRO QUE INTERFEREM NOS RESULTADOS DA FASE DE TERMINAÇÃO; FATORES AMBIENTAIS A SEREM CONSIDERADOS NA ESCOLHA DO SISTEMA DE TERMINAÇÃO DE CORDEIROS; ASPECTOS ECONÔMICOS DA TERMINAÇÃO DE CORDEIROS À PASTO E EM CONFINAMENTO; TIPO DE TERMINAÇÃO DE CORDEIROS E AS ALTERNATIVAS PARA UMA PRODUÇÃO DE CARNE OVINA DIFERENCIADA

The Power of Non-Determinism in Higher-Order Implicit Complexity

We investigate the power of non-determinism in purely functional programming languages with higher-order types. Specifically, we consider cons-free programs of varying data orders, equipped with explicit non-deterministic choice. Cons-freeness roughly means that data constructors cannot occur in function bodies and all manipulation of storage space thus has to happen indirectly using the call stack. While cons-free programs have previously been used by several authors to characterise complexity classes, the work on non-deterministic programs has almost exclusively considered programs of data order 0. Previous work has shown that adding explicit non-determinism to cons-free programs taking data of order 0 does not increase expressivity; we prove that this - dramatically - is not the case for higher data orders: adding non-determinism to programs with data order at least 1 allows for a characterisation of the entire class of elementary-time decidable sets. Finally we show how, even with non-deterministic choice, the original hierarchy of characterisations is restored by imposing different restrictions.Comment: pre-edition version of a paper accepted for publication at ESOP'1