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

Factors Associated with Tuberculosis and Rifampicin-Resistant Tuberculosis amongst Symptomatic Patients in India: A Retrospective Analysis

Background Tuberculosis remains a major public health challenge for India. Various studies have documented different levels of TB and multi-drug resistant (MDR) TB among diverse groups of the population. In view of renewed targets set under the End TB strategy by 2035, there is an urgent need for TB diagnosis to be strengthened. Drawing on data from a recent, multisite study, we address key questions for TB diagnosis amongst symptomatics presenting for care: are there subgroups of patients that are more likely than others, to be positive for TB? In turn, amongst these positive cases, are there factors—apart from treatment history—that may be predictive for multi-drug resistance? Methods We used data from a multi-centric prospective demonstration study, conducted from March 2012 to December 2013 in 18 sub-district level TB programme units (TUs) in India and covering a population of 8.8 million. In place of standard diagnostic tests, upfront Xpert MTB/RIF testing was offered to all presumptive TB symptomatics. Here, using data from this study, we used logistic regression to identify association between risk factors and TB and Rifampicin-Resistant TB among symptomatics enrolled in the study. Results We find that male gender; history of TB treatment; and adult age compared with either children or the elderly are risk factors associated with high TB detection amongst symptomatics, across the TUs. While treatment history is found be a significant risk factor for rifampicin-resistant TB, elderly (65+ yrs) people have significantly lower risk than other age groups. However, pediatric TB cases have no less risk of rifampicin resistance as compared with adults (OR 1.23 (95% C.I. 0.85–1.76)). Similarly, risk of rifampicin resistance among both the genders was the same. These patterns applied across the study sites involved. Notably in Mumbai, amongst those patients with microbiological confirmation of TB, female patients showed a higher risk of having MDR-TB than male patients. Conclusion Our results cast fresh light on the characteristics of symptomatics presenting for care who are most likely to be microbiologically positive for TB, and for rifampicin resistance. The challenges posed by TB control are complex and multifactorial: evidence from diverse sources, including retrospective studies such as that addressed here, can be invaluable in informing future strategies to accelerate declines in TB burden

Mountain-Shaped Coupler for Ultra Wideband Applications

This paper demonstrates a novel mountain-shaped design for a compact 3-dB coupler operating at ultra-wideband (UWB) frequencies from 3.1GHz to 10.6 GHz. The proposed design was accomplished using multilayer technology in which the structure is formed by three layers of conductors interleaved by a layer of substrate between each conductor layer. Simulation was carried out using CST Microwave Studio; the result was then compared with results from rectangular and star-shaped couplers that implemented the same technique. The results obtained show that the proposed new coupler has better performance compared to both rectangular and star-shaped coupler designs in terms of return loss, isolation, and phase difference. The coupler was fabricated and measured; the measurement results satisfactorily agree with the simulation results

An Economic Study of the Effect of Android Platform Fragmentation on Security Updates

Vendors in the Android ecosystem typically customize their devices by modifying Android Open Source Project (AOSP) code, adding in-house developed proprietary software, and pre-installing third-party applications. However, research has documented how various security problems are associated with this customization process. We develop a model of the Android ecosystem utilizing the concepts of game theory and product differentiation to capture the competition involving two vendors customizing the AOSP platform. We show how the vendors are incentivized to differentiate their products from AOSP and from each other, and how prices are shaped through this differentiation process. We also consider two types of consumers: security-conscious consumers who understand and care about security, and na\"ive consumers who lack the ability to correctly evaluate security properties of vendor-supplied Android products or simply ignore security. It is evident that vendors shirk on security investments in the latter case. Regulators such as the U.S. Federal Trade Commission have sanctioned Android vendors for underinvestment in security, but the exact effects of these sanctions are difficult to disentangle with empirical data. Here, we model the impact of a regulator-imposed fine that incentivizes vendors to match a minimum security standard. Interestingly, we show how product prices will decrease for the same cost of customization in the presence of a fine, or a higher level of regulator-imposed minimum security.Comment: 22nd International Conference on Financial Cryptography and Data Security (FC 2018

High resolution evidence for the Garrett-Munk spectrum of stratospheric gravity waves

Vertical profiles of scalar horizontal winds have been measured at high resolution (10 m) in the 13 to 37 km region of the stratosphere. This resolution (at that range of altitude) represents the state-of-the-art, and is unique. The technique used smoke trails laid by rockets in the stratosphere, and were taken by AFGL at Wallops Island, VA, White Sands Missile Range, NM, and Ft. Churchill, Canada, in the 1977-78 time period. Two or three cameras were used to give the time-lapse photographs. The goal was to ascertain whether or not the internal waves of the stratosphere behave consistently with the Garrett-Munk model which was originally created for oceanic internal waves. Five profiles of horizontal wind are presented. It is concluded: (1) stratospheric internal waves obey the Garrett-Munk model for vertical wave numbers; (2) there is not statistically significant evidence for a break in the curve at high wave numbers when due allowance is made for aliasing effects; and (3) the power density level of the spectra are almost equal on a log-log scale in spite of the difference in time, season, and geographical location

The Improvement of first Iteration Log Periodic Fractal Koch Antenna with Slot Implementation

In this paper, a slotted is introduced at each of the radiating elements on the 1st iteration log periodic fractal Koch antenna (LPFKA). The antenna is designed to testify the appropriate performance at UHF Digital television which operates from 4.0 GHz to 1.0 GHz. The dimension of the conventional 0th iteration LPKFA is successfully reduced by 17% with the implementation of slotted. The results show a good agreement with a stable radiation pattern across the operating bandwidth, stable gain more than 5 dBi and reflection coefficient of below -10 dB over the desired frequency range

Strategy for selection of elements for heat transfer enhancement

Abstract The present paper points out that the selection of elements for heat transfer enhancement in heat exchangers requires a methodology to make a direct comparison of the performances of heat exchanger surfaces with different elements. Methods of comparison used in the past are, in many respects, approximate and hence fail to predict accurately the relative performance of conventional heat exchanger surfaces operated with different heat exchanger elements. Owing to the direct use of the Colburn factor for performance assessment, these methods over-predict the relative performance of heat exchangers. In the present paper, a more consistent comparison method is presented and is demonstrated to work by comparison of the performance of an experimentally investigated pin fin heat exchanger with that of a smooth pipe heat exchanger. The method yields results that belong to the volume goodness factors group. It represents a practical approach, as it is applicable to all kinds of heat exchanger surfaces and does not require the conversion of the experimental data in terms of Nusselt number and friction factor for comparison purposes. The present work demonstrates that the suggested method can also be used for performance comparison of existing heat exchanger surfaces with available heat transfer and pressure loss data

On the location of the zeros of analytic functions

In this paper we obtain regions containing all the zeros of a class of analytic functions whose coefficients are subject to certain conditions. Our results sharpen some of the results known in this direction. Also we give some examples to show that in some cases the regions obtained by our results are considerably sharper than the regions obtained by known results

Use of Xpert MTB/RIF in Decentralized Public Health Settings and Its Effect on Pulmonary TB and DR-TB Case Finding in India

Background Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in high-burden settings. This study assessed the impact of up-front Xpert MTB/RIF testing on detection of pulmonary tuberculosis (PTB) and rifampicin-resistant PTB (DR-TB) cases in India. Methods This demonstration study was implemented in 18 sub-district level TB programme units (TUs) in India in diverse geographic and demographic settings covering a population of 8.8 million. A baseline phase in 14 TUs captured programmatic baseline data, and an intervention phase in 18 TUs had Xpert MTB/RIF offered to all presumptive TB patients. We estimated changes in detection of TB and DR-TB, the former using binomial regression models to adjust for clustering and covariates. Results In the 14 study TUs, which participated in both phases, 10,675 and 70,556 presumptive TB patients were enrolled in the baseline and intervention phase, respectively, and 1,532 (14.4%) and 14,299 (20.3%) bacteriologically confirmed PTB cases were detected. The implementation of Xpert MTB/RIF was associated with increases in both notification rates of bacteriologically confirmed TB cases (adjusted incidence rate ratio [aIRR] 1.39; CI 1.18-1.64), and proportion of bacteriological confirmed TB cases among presumptive TB cases (adjusted risk ratio (aRR) 1.33; CI 1.6-1.52). Compared with the baseline strategy of selective drug-susceptibility testing only for PTB cases at high risk of drug-resistant TB, Xpert MTB/RIF implementation increased rifampicin resistant TB case detection by over fivefold. Among, 2765 rifampicin resistance cases detected, 1055 were retested with conventional drug susceptibility testing (DST). Positive predictive value (PPV) of rifampicin resistance detected by Xpert MTB/RIF was 94.7% (CI 91.3-98.1), in comparison to conventional DST. Conclusion Introduction of Xpert MTB/RIF as initial diagnostic test for TB in public health facilities significantly increased case-notification rates of all bacteriologically confirmed TB by 39% and rifampicin-resistant TB case notification by fivefold