Outcomes analysis of new entrant screening for active tuberculosis in Heathrow and Gatwick airports, United Kingdom 2009/2010

BACKGROUND: In 2012, the United Kingdom (UK) Government announced that the new entrant screening for active tuberculosis (TB) in Heathrow and Gatwick airports would end. Our study objective was to estimate screening yield and diagnostic accuracy, and identify those at risk of active TB after entry. METHODS: We designed a retrospective cohort study and linked new entrants screened from June 2009 to September 2010 through probabilistic matching with UK Enhanced TB Surveillance (ETS) data (June 2009 to December 2010). Yield was the proportion of cases reported to ETS within three months of airport screening in the screened population. To estimate screening diagnostic accuracy we assessed sensitivity, specificity, positive and negative predictive values. Through Poisson regression we identified groups at increased risk of TB diagnosis after entry. RESULTS: We identified 200,199 screened entrants, of these 59 had suspected TB at screening and were reported within 3 months to ETS (yield = 0.03 %). Sensitivity was 26 %; specificity was 99.7 %; positive predictive value was 13.2 %; negative predictive value was 99.9 %. Overall, 350 entrants were reported in ETS. Persons from countries with annual TB incidence higher than 150 cases per 100,000 population and refugees and asylum seekers were at increased risk of TB diagnosis after entry (population attributable risk 77 and 3 % respectively). CONCLUSION: Airport screening has very low screening yields, sensitivity and positive predictive value. New entrants coming from countries with annual TB incidence higher than 150 per 100,000 population, refugees and asylum seekers should be prioritised at pre- or post-entry screening

Cross-aisle seismic performance of selective storage racks

© 2020 A series of single-axis shaking table tests were conducted on three full-scale selective storage racks in the cross-aisle direction. The uplifting and rocking behaviour of the racks was examined under three baseplate types: ductile, heavy duty, and unanchored. Each rack was subjected to a sequence of ground motions of increasing intensity up to failure, with a total of 29 tests conducted. At 1.5 times the respective design level ground motions, the heavy duty baseplates caused a foundation failure while the unanchored rack failed by overturning. The rack with ductile baseplates survived all tests up to 2.3 times the design level. For a given ground motion, the unanchored rack upright always had the smallest peak axial load. However, the unanchored rack had much larger sways under the Northbridge and Kobe ground motions. The NZS 1170.5 equivalent static method design loading was found to be overly conservative for racks with ductile and heavy duty baseplates, of which the upright design axial forces were better predicted using the refined equivalent static method

Terpyridyl complexes as antimalarial agents

A number of transition metals and their terpyridyl complexes have been evaluated for antimalarial activity on the strain 3D7. The metals, ligands and complexes were each in turn investigated for their efficacy. All activities were in the sub-micromolar range (0.1-1 µM). Their modes of action were compared with that of chloroquine to discover whether or not they were capable of inhibiting haemozoin formation. The data indicate that efficacy could be a result of several mechanisms and that speciation of the metal complex and the manner in which the agents are added to the parasitic broth have a profound effect on the activity of the agents. We believe that our study offers a template by which other researchers should approach their experiments using transition metal complex agents

Interacting supernovae and supernova impostors. SN 2007sv: the major eruption of a massive star in UGC 5979

We report the results of the photometric and spectroscopic monitoring campaign of the transient SN 2007sv. The observables are similar to those of type IIn supernovae, a well-known class of objects whose ejecta interact with pre-existing circum-stellar material. The spectra show a blue continuum at early phases and prominent Balmer lines in emission, however, the absolute magnitude at the discovery of SN 2007sv (M_R = - 14.25 +/- 0.38) indicate it to be most likely a supernova impostor. This classification is also supported by the lack of evidence in the spectra of very high velocity material as expected in supernova ejecta. In addition we find no unequivocal evidence of broad lines of alpha - and/or Fe-peak elements. The comparison with the absolute light curves of other interacting objects (including type IIn supernovae) highlights the overall similarity with the prototypical impostor SN 1997bs. This supports our claim that SN 2007sv was not a genuine supernova, and was instead a supernova impostor, most likely similar to the major eruption of a luminous blue variable.Comment: Accepted for publication in MNRAS. 15 pages, 11 figures, 5 table

Applying acceptance requirements to requirements modeling tools via gamification: a case study on privacy and security.

Requirements elicitation, analysis and modeling are critical activities for software success. However, software systems are increasingly complex, harder to develop due to an ever-growing number of requirements from numerous and heterogeneous stakeholders, concerning dozens of requirements types, from functional to qualitative, including adaptation, security and privacy, ethical, acceptance and more. In such settings, requirements engineers need support concerning such increasingly complex activities, and Requirements Engineering (RE) modeling tools have been developed for this. However, such tools, although effective, are complex, time-consuming and requiring steep learning curves. The consequent lack of acceptance and abandonment in using such tools, by engineers, paves the way to the application of RE techniques in a more error-prone, low-quality way, increasing the possibility to have failures in software systems delivered. In this paper, we identify main areas of lack of acceptance, affecting RE engineers, for such tools, and propose an approach for making modeling tools more effective in engaging the engineer in performing RE in a tool-based way, receiving adequate feedback and staying motivated to use modeling tools. This is accomplished by performing acceptance requirements analysis (through the Agon Framework) and using gamification to increase the engagement of engineers during the usage of RE modeling tools. Towards this end, we performed a case study, within the VisiOn European Project, for enhancing a tool for modeling privacy and security requirements. Our case study provides preliminary evidence that our approach supports in making RE modeling tools more engaging from the engineer perspective

An evaluation of tuberculosis contact investigations against national standards.

BACKGROUND: Contact tracing is a key element in England's 2015 collaborative TB strategy, although proposed indicators of successful contact tracing remain undescribed. METHODS: We conducted descriptive and multivariable analyses of contact tracing of TB cases in London between 1 July 2012 and 31 December 2015 using cohort review data from London's TB Register, identifying characteristics associated with improved indicators and yield. RESULTS: Of the pulmonary TB cases notified, 60% (2716/4561) had sufficient information for inclusion. Of these, 91% (2481/2716) had at least 1 contact (median: 4/case (IQR: 2-6)) identified, with 86% (10 251/11 981) of these contacts evaluated. 4.1% (177/4328), 1.3% (45/3421) and 0.70% (51/7264) of evaluated contacts of pulmonary smear-positive, pulmonary smear-negative and non-pulmonary cases, respectively, had active disease. Cases who were former prisoners or male were less likely to have at least one contact identified than those never imprisoned or female, respectively. Cases diagnosed at clinics with more directly observed therapy or social workers were more likely to have one or more contacts identified. Contacts screened at a different clinic to their index case or of male index cases were less likely to be evaluated than those screened at the same clinic or of women, respectively; yield of active disease was similar by sex. 10% (490/4850) of evaluated child contacts had latent TB infection. CONCLUSIONS: These are the first London-wide estimates of TB contact tracing indicators which are important for monitoring the strategy's success and informing risk assessment of index cases. Understanding why differences in indicators occur between groups could improve contact tracing outcomes

Should NICE reconsider the 2016 UK guidelines on TB contact tracing? A cost-effectiveness analysis of contact investigations in London.

BACKGROUND: In January 2016, clinical TB guidance in the UK changed to no longer recommend screening contacts of non-pulmonary, non-laryngeal (ETB) index cases. However, no new evidence was cited for this change, and there is evidence that screening these contacts may be worthwhile. The objective of this study was to estimate the cost-effectiveness of screening contacts of adult ETB cases and adult pulmonary or laryngeal TB (PTB) cases in London, UK. METHODS: We carried out a cross-sectional analysis of data collected on TB index cases and contacts in the London TB register and an economic evaluation using a static model describing contact tracing outcomes. Incremental cost-effectiveness ratios (ICERs) were calculated using no screening as the baseline comparator. All adult TB cases (≥15 years old) in London from 2012 to 2015, and their contacts, were eligible (2465/5084 PTB and 2559/6090 ETB index cases were included). RESULTS: Assuming each contact with PTB infects one person/month, the ICER of screening contacts of ETB cases was £78 000/quality-adjusted life-years (QALY) (95% CI 39 000 to 140 000), and screening contacts of PTB cases was £30 000/QALY (95% CI 18 000 to 50 000). The ICER of screening contacts of ETB cases was £30 000/QALY if each contact with PTB infects 3.4 people/month. Limitations of this study include the use of self-reported symptomatic periods and lack of knowledge about onward transmission from PTB contacts. CONCLUSIONS: Screening contacts of ETB cases in London was almost certainly not cost-effective at any conventional willingness-to-pay threshold in England, supporting recent changes to National Institute for Health and Care Excellence national guidelines

Prospects for local co-governance

British local authorities and their partners are increasingly developing new ways of working together with local communities. The nature of this co-working, however, is complex, multi-faceted and little understood. This article argues for greater clarity of thinking on the topic, by analysing this co-working as a form of political co-governance, and drawing attention in particular to issues of scale and democracy. Using evidence from a study of 43 local authority areas, 16 authorities are identified where co-governance is practised, following three main types of approach: service-influencing, service-delivering and parish council developing. It is concluded that strengthening political co-governance is essential for a healthy democracy