Treatment of Tuberculosis in Complex Emergencies in Developing Countries: A Scoping Review

Almost 172 million people live in complex emergencies globally resulting from political and/or economic instability. The provision and continuity of health care in complex emergencies remain a significant challenge. Health agencies are often hesitant to implement tuberculosis programmes in particular because its treatment requires a longer commitment than most acute diseases. However, not treating tuberculosis promptly increases mortality and untreated tuberculosis further increases the incidence of tuberculosis. Given that complex emergencies are increasing globally, there is an urgent need to analyse the available evidence to improve our understanding of how best to deliver tuberculosis programmes in such settings. Using a scoping review method, we selected and analysed fifteen studies on tuberculosis programmes in complex emergencies. We found that despite the challenges, tuberculosis programmes have been successful in complex emergencies. We identified seven cross-cutting factors that were found to be important: service providers and treatment regime, training and supervision, donor support, adherence, leadership and coordination, monitoring, and government and community support. In general, programmes showed greater creativity and flexibility to adapt to the local conditions and at times, it also meant diverting from the WHO guidelines. We identify areas of further research including the need to study the effectiveness of programmes that divert from the WHO guidelines and their implication on drug resistance

The Influence of Nutrients and Physical Habitat in Regulating Algal Biomass in Agricultural Streams

This study examined the relative influence of nutrients (nitrogen and phosphorus) and habitat on algal biomass in five agricultural regions of the United States. Sites were selected to capture a range of nutrient conditions, with 136 sites distributed over five study areas. Samples were collected in either 2003 or 2004, and analyzed for nutrients (nitrogen and phosphorous) and algal biomass (chlorophyll a). Chlorophyll a was measured in three types of samples, fine-grained benthic material (CHLFG), coarse-grained stable substrate as in rock or wood (CHLCG), and water column (CHLS). Stream and riparian habitat were characterized at each site. TP ranged from 0.004–2.69 mg/l and TN from 0.15–21.5 mg/l, with TN concentrations highest in Nebraska and Indiana streams and TP highest in Nebraska. Benthic algal biomass ranged from 0.47–615 mg/m2, with higher values generally associated with coarse-grained substrate. Seston chlorophyll ranged from 0.2–73.1 lg/l, with highest concentrations in Nebraska. Regression models were developed to predict algal biomass as a function of TP and/or TN. Seven models were statistically significant, six for TP and one for TN; r2 values ranged from 0.03 to 0.44. No significant regression models could be developed for the two study areas in the Midwest. Model performance increased when stream habitat variables were incorporated, with 12 significant models and an increase in the r2 values (0.16–0.54). Water temperature and percent riparian canopy cover were the most important physical variables in the models. While models that predict algal chlorophyll a as a function of nutrients can be useful, model strength is commonly low due to the overriding influence of stream habitat. Results from our study are presented in context of a nutrient-algal biomass conceptual model

Digestive plasticity of the small intestine and the fermentative hindgut in a marsupial herbivore, the tammar wallaby (Macropus eugenii)

We investigated the effects of a ground, pelleted diet versus natural forage on the gross morphology of the gastrointestinal tract of a medium- sized (5 - 7 kg body mass) macropodid marsupial, the tammar wallaby ( Macropus eugenii). The empty wet mass ( g) of the small intestine of tammar wallabies maintained on a pelleted diet for 6 weeks was 22% greater than that of animals maintained on natural forage, once body mass was taken into account by ANCOVA. Similarly, the body-mass-adjusted length of the tammar wallaby caecum and proximal colon combined was 25% longer in animals maintained on the pelleted diet compared with those maintained on forage. Our data suggest that food particle size may be directly involved in controlling the size of the post-gastric alimentary tract in tammar wallabies, and thus in their diet choice and nutritional ecology. Notably, this is the first study that links phenotypic plasticity of the gut directly to diet in a marsupial and we conclude that the tammar wallaby is an excellent model for exploring the causes and consequences of digestive plasticity in macropodid marsupials

Severe Pneumomediastinum Complicating EBUS-TBNA

Pneumomediastinum infrequently complicates diagnostic bronchoscopy. Increased airway or alveolar pressure results in air leaks to the mediastinum through existing or induced defects. Excessive cough, recurrent episodes of increased abdominal pressure, vomiting, or sneezing can all induce spontaneous pneumomediastinum. Less commonly it has been documented with lung or neck infections, esophageal or tracheal tears, and rapid increases in altitude such as during plane flights or scuba diving, with mechanical ventilation, substance abuse, and after bronchoscopy. Pneumomediastinum may be, but is not always, associated with pneumothorax

Inverse monoids and immersions of 2-complexes

It is well known that under mild conditions on a connected topological space $\mathcal X$, connected covers of $\mathcal X$ may be classified via conjugacy classes of subgroups of the fundamental group of $\mathcal X$. In this paper, we extend these results to the study of immersions into 2-dimensional CW-complexes. An immersion $f : {\mathcal D} \rightarrow \mathcal C$ between CW-complexes is a cellular map such that each point $y \in {\mathcal D}$ has a neighborhood $U$ that is mapped homeomorphically onto $f(U)$ by $f$. In order to classify immersions into a 2-dimensional CW-complex $\mathcal C$, we need to replace the fundamental group of $\mathcal C$ by an appropriate inverse monoid. We show how conjugacy classes of the closed inverse submonoids of this inverse monoid may be used to classify connected immersions into the complex

Lessons learned in implementing a demand side management contract at the Presidio of San Francisco

The National Park Service (NSP) recently completed the implementation phase of its Power Saving Partners (PSP) Demand Side Management (DSM) contract with the local utility, Pacific Gas and Electric (PG&E). Through the DSM contract, NPS will receive approximately $4.1 million over eight years in payment for saving 61 kW of electrical demand, 179,000 km of electricity per year, and 1.1 million therms of natural gas per year. These payments are for two projects: the installation of high-efficiency lighting systems at the Thoreau Center for Sustainability and the replacement of an old central boiler plant with new, distributed boilers. Although these savings and payments are substantial, the electrical savings and contract payments fall well short of the projected 1,700 kW of electrical demand, 8 million kwh of annual electricity savings, and$11 million in payments, anticipated at the project's onset. Natural gas savings exceeded the initial forecast of 800,000 therms per year. The DSM contract payments did not meet expectations for a variety of reasons which fall into two broad categories: first, many anticipated projects were not constructed, and second, some of the projects that were constructed were not included in the program because the cost of implementing the DSM program's measurement and verification (M&V) requirements outweighed anticipated payments. This paper discusses the projects implemented, and examines the decisions made to withdraw some of them from the DSM contract. It also presents the savings that were realized and documented through M&V efforts. Finally, it makes suggestions relative to M&V protocols to encourage all efficiency measures, not just those that are easy to measure