Retooling existing tuberculosis drugs for children.

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Constrained Density Functional Theory: A Potential-Based Self-Consistency Approach

Chemical reactions, charge transfer reactions, and magnetic materials are notoriously difficult to describe within Kohn−Sham density functional theory, which is strictly a groundstate technique. However, over the last few decades, an approximate method known as constrained density functional theory (cDFT) has been developed to model low-lying excitations linked to charge transfer or spin fluctuations. Nevertheless, despite becoming very popular due to its versatility, low computational cost, and availability in numerous software applications, none of the previous cDFT implementations is strictly similar to the corresponding ground-state self-consistent density functional theory: the target value of constraints (e.g., local magnetization) is not treated equivalently with atomic positions or lattice parameters. In the present work, by considering a potential-based formulation of the self-consistency problem, the cDFT is recast in the same framework as Kohn−Sham DFT: a new functional of the potential that includes the constraints is proposed, where the constraints, the atomic positions, or the lattice parameters are treated all alike, while all other ingredients of the usual potentialbased DFT algorithms are unchanged, thanks to the formulation of the adequate residual. Tests of this approach for the case of spin constraints (collinear and noncollinear) and charge constraints are performed. Expressions for the derivatives with respect to constraints (e.g., the spin torque) for the atomic forces and the stress tensor in cDFT are provided. The latter allows one to study striction effects as a function of the angle between spins. We apply this formalism to body-centered cubic iron and first reproduce the well-known magnetization amplitude as a function of the angle between local magnetizations. We also study stress as a function of such an angle. Then, the local collinear magnetization and the local atomic charge are varied together. Since the atomic spin magnetizations, local atomic charges, atomic positions, and lattice parameters are treated on an equal footing, this formalism is an ideal starting point for the generation of model Hamiltonians and machine-learning potentials, computation of second or third derivatives of the energy as delivered from density-functional perturbation theory, or for second-principles approaches

A review of methods for detecting rats at low densities, with implications for surveillance

Invasive rats are the biggest threat to island biodiversity world-wide. Though the ecological impacts of rats on insular biota are well documented, introduced rats present a difficult problem for detection and management. In recent decades, improved approaches have allowed for island-wide eradications of invasive rats on small-medium sized islands and suppression on large islands, although both these still represent a formidable logistical and financial challenge. A key aspect of eradication or suppression and ongoing management is the ability to detect the presence of rats, especially at low densities. Here we review recent developments in the field of rat surveillance and summarise current published literature to recommend practices and the factors to consider when developing a surveillance program for either eradication or suppression plans. Of 51 empirical studies covering 17 countries, 58% were from New Zealand. Although detecting rats at low density is extremely challenging, advances over the past 15 years, have significantly improved our ability to detect rats. Motion-sensored cameras and rodent detection dogs have greatly improved our ability to detect rats at low densities, with cameras consistently showing an ability to detect rats at lower densities than other techniques. Rodent detection dogs are also able to reliably detect even an individual rat, although there are challenges to their widespread adoption, particularly in developing countries, due to the cost and skills required for their training and maintenance. New monitoring devices, the use of eDNA and drones represent current and future innovations to improve detection

Linezolid for Children With Tuberculous Meningitis: More Evidence Required.

Tuberculous meningitis (TBM) is a devastating disease. With the currently available treatment regimens one in five children die and only a third of surviving children escape neurological sequelae.1 If there was any way of improving these outcomes significant mortality and morbidity would be averted. We were greatly interested, therefore, to read the study by Li et al regarding the use of linezolid in children with TBM in Beijing

Liquid crystal alignment induced by micron-scale patterned surfaces

Induced bulk orientation of nematic liquid crystal in contact with micron-scale patterned surfaces is investigated using the Landau-de Gennes theory by means of three-dimensional simulations. The effect of the size and spacing of square cross-sectional well and post patterns is investigated and shown to influence the orientation of the liquid crystal bulk, far removed from the surface. Additionally, the effective anchoring strength of the induced alignment is estimated using a modified version of the torque balance method. Both azimuthal and zenithal multistability are shown to exist within unique ranges of feature sizes

Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis

BACKGROUND: Paediatric multidrug-resistant (MDR) tuberculosis is a public health challenge of growing concern, accounting for an estimated 15% of all global cases of MDR tuberculosis. Clinical management is especially challenging, and recommendations are based on restricted evidence. We aimed to assess existing evidence for the treatment of MDR tuberculosis in children. METHODS: We did a systematic review and meta-analysis of published and unpublished studies reporting treatment outcomes for children with MDR tuberculosis. We searched PubMed, Ovid, Embase, Cochrane Library, PsychINFO, and BioMedCentral databases up to Oct 31, 2011. Eligible studies included five or more children (aged ≤16 years) with MDR tuberculosis within a defined treatment cohort. The primary outcome was treatment success, defined as a composite of cure and treatment completion. RESULTS: We identified eight studies, which reported treatment outcomes for a total of 315 patients. We recorded much variation in the characteristics of patients and programmes. Time to appropriate treatment varied from 2 days to 46 months. Average duration of treatment ranged from 6 months to 34 months, and duration of follow-up ranged from 12 months to 37 months. The pooled estimate for treatment success was 81·67% (95% CI 72·54-90·80). Across all studies, 5·9% (95% CI 1·3-10·5) died, 6·2% (2·3-10·2) defaulted, and 39·1% (28·7-49·4) had an adverse event. The most common drug-related adverse events were nausea and vomiting. Other serious adverse events were hearing loss, psychiatric effects, and hypothyroidism. INTERPRETATION: The treatment of paediatric MDR tuberculosis has been neglected, but when children are treated outcomes can be achieved that are at least as good as those reported for adults. Programmes should be encouraged to report outcomes in children to improve the knowledge base for care, especially as new drugs become available. FUNDING: None

The Wonder Years: What Can Primary School Children Teach Us About Immunity to Mycobacterium tuberculosis?

In high burden settings, the risk of infection with Mycobacterium tuberculosis increases throughout childhood due to cumulative exposure. However, the risk of progressing from tuberculosis (TB) infection to disease varies by age. Young children (<5 years) have high risk of disease progression following infection. The risk falls in primary school children (5 to <10 years), but rises again during puberty. TB disease phenotype also varies by age: generally, young children have intrathoracic lymph node disease or disseminated disease, while adolescents (10 to <20 years) have adult-type pulmonary disease. TB risk also exhibits a gender difference: compared to adolescent boys, adolescent girls have an earlier rise in disease progression risk and higher TB incidence until early adulthood. Understanding why primary school children, during what we term the “Wonder Years,” have low TB risk has implications for vaccine development, therapeutic interventions, and diagnostics. To understand why this group is at low risk, we need a better comprehension of why younger children and adolescents have higher risks, and why risk varies by gender. Immunological response to M. tuberculosis is central to these issues. Host response at key stages in the immunopathological interaction with M. tuberculosis influences risk and disease phenotype. Cell numbers and function change dramatically with age and sexual maturation. Young children have poorly functioning innate cells and a Th2 skew. During the “Wonder Years,” there is a lymphocyte predominance and a Th1 skew. During puberty, neutrophils become more central to host response, and CD4+ T cells increase in number. Sex hormones (dehydroepiandrosterone, adiponectin, leptin, oestradiol, progesterone, and testosterone) profoundly affect immunity. Compared to girls, boys have a stronger Th1 profile and increased numbers of CD8+ T cells and NK cells. Girls are more Th2-skewed and elicit more enhanced inflammatory responses. Non-immunological factors (including exposure intensity, behavior, and co-infections) may impact disease. However, given the consistent patterns seen across time and geography, these factors likely are less central. Strategies to protect children and adolescents from TB may need to differ by age and sex. Further work is required to better understand the contribution of age and sex to M. tuberculosis immunity

The current global situation for tuberculous meningitis : epidemiology, diagnostics, treatment and outcomes [version 1; peer review: 2 approved]

CITATION: Seddon, J., et al. 2019. The current global situation for tuberculous meningitis : epidemiology, diagnostics, treatment and outcomes [version 1; peer review: 2 approved]. Wellcome Open Research, 4:167, doi:10.12688/wellcomeopenres.15535.1.The original publication is available at https://wellcomeopenresearch.orgTuberculous meningitis (TBM) results from dissemination of M. tuberculosis to the cerebrospinal fluid (CSF) and meninges. Ischaemia, hydrocephalus and raised intracranial pressure frequently result, leading to extensive brain injury and neurodisability. The global burden of TBM is unclear and it is likely that many cases are undiagnosed, with many treated cases unreported. Untreated, TBM is uniformly fatal, and even if treated, mortality and morbidity are high. Young age and human immunodeficiency virus (HIV) infection are potent risk factors for TBM, while Bacillus Calmette–Guérin (BCG) vaccination is protective, particularly in young children. Diagnosis of TBM usually relies on characteristic clinical symptoms and signs, together with consistent neuroimaging and CSF parameters. The ability to confirm the TBM diagnosis via CSF isolation of M. tuberculosis depends on the type of diagnostic tests available. In most cases, the diagnosis remains unconfirmed. GeneXpert MTB/RIF and the next generation Xpert Ultra offer improved sensitivity and rapid turnaround times, and while roll-out has scaled up, availability remains limited. Many locations rely only on acid fast bacilli smear, which is insensitive. Treatment regimens for TBM are based on evidence for pulmonary tuberculosis treatment, with little consideration to CSF penetration or mode of drug action required. The World Health Organization recommends a 12-month treatment course, although data on which to base this duration is lacking. New treatment regimens and drug dosages are under evaluation, with much higher dosages of rifampicin and the inclusion of fluoroquinolones and linezolid identified as promising innovations. The inclusion of corticosteroids at the start of treatment has been demonstrated to reduce mortality in HIV-negative individuals but whether they are universally beneficial is unclear. Other host-directed therapies show promise but evidence for widespread use is lacking. Finally, the management of TBM within health systems is sub-optimal, with drop-offs at every stage in the care cascade.https://wellcomeopenresearch.org/articles/4-167Publisher's versio

Decision-making in the diagnosis of tuberculous meningitis

CITATION: Boyles, Tom H. et al. 2020. Decision-making in the diagnosis of tuberculous meningitis. Wellcome Open Research, 5:11, doi:10.12688/wellcomeopenres.15611.1.The original publication is available at: https://pubmed.ncbi.nlm.nih.govENGLISH ABSTRACT: Tuberculous meningitis (TBM) is the most devastating form of tuberculosis (TB) but diagnosis is difficult and delays in initiating therapy increase mortality. All currently available tests are imperfect; culture of Mycobacterium tuberculosis from the cerebrospinal fluid (CSF) is considered the most accurate test but is often negative, even when disease is present, and takes too long to be useful for immediate decision making. Rapid tests that are frequently used are conventional Ziehl-Neelsen staining and nucleic acid amplification tests such as Xpert MTB/RIF and Xpert MTB/RIF Ultra. While positive results will often confirm the diagnosis, negative tests frequently provide insufficient evidence to withhold therapy. The conventional diagnostic approach is to determine the probability of TBM using experience and intuition, based on prevalence of TB, history, examination, analysis of basic blood and CSF parameters, imaging, and rapid test results. Treatment decisions may therefore be both variable and inaccurate, depend on the experience of the clinician, and requests for tests may be inappropriate. In this article we discuss the use of Bayes' theorem and the threshold model of decision making as ways to improve testing and treatment decisions in TBM. Bayes' theorem describes the process of converting the pre-test probability of disease to the post-test probability based on test results and the threshold model guides clinicians to make rational test and treatment decisions. We discuss the advantages and limitations of using these methods and suggest that new diagnostic strategies should ultimately be tested in randomised trials.Publisher's versio