Measurement of Magnetic Relaxation in the peak regime of V3Si

Magnetization relaxation measurements are carried out in the Peak effect regime of superconducting V3Si crystal, using Quantum Design SQUID magnetometer. Relaxation in the increasing field scan is logarithmic in time, consistent with the theory of flux creep. The relaxation on the decreasing field scan however exhibits athermal behavior which is predominantly governed by the flux avalanches triggered by the small external field perturbation experienced by the superconductor during measurement scan in an inhomogeneous field.Comment: PDF, 17 pages including 9 figure

Comparison of History Effects in Magnetization in Weakly pinned Crystals of high-TcT_c and low-Tc_c Superconductors

A comparison of the history effects in weakly pinned single crystals of a high $T_c$ YBa$_2$Cu$_3$O$_{7 - \delta}$ (for H $\parallel$ c) and a low $T_c$ Ca$_3$Rh$_4$Sn$_{13}$, which show anomalous variations in critical current density $J_c(H)$ are presented via tracings of the minor magnetization hysteresis loops using a vibrating sample magnetometer. The sample histories focussed are, (i) the field cooled (FC), (ii) the zero field cooled (ZFC) and (iii) an isothermal reversal of field from the normal state. An understanding of the results in terms of the modulation in the plastic deformation of the elastic vortex solid and supercooling across order-disorder transition is sought.Comment: Presented in IWCC-200

Field Assessment of a Model Tuberculosis Outbreak Response Plan for Low-Incidence Areas

Background: For a regional project in four low-incidence states, we designed a customizable tuberculosis outbreak response plan. Prior to dissemination of the plan, a tuberculosis outbreak occurred, presenting an opportunity to perform a field assessment of the plan. The purpose of the assessment was to ensure that the plan included essential elements to help public health professionals recognize and respond to outbreaks. Methods: We designed a semi-structured questionnaire and interviewed all key stakeholders involved in the response. We used common themes to assess validity of and identify gaps in the plan. A subset of participants provided structured feedback on the plan. Results: We interviewed 11 public health and six community stakeholders. The assessment demonstrated that (1) almost all of the main response activities were reflected in the plan; (2) the plan added value by providing a definition of a tuberculosis outbreak and guidelines for communication and evaluation. These were areas that lacked written protocols during the actual outbreak response; and (3) basic education about tuberculosis and the interpretation and use of genotyping data were important needs. Stakeholders also suggested adding to the plan questions for evaluation and a section for specific steps to take when an outbreak is suspected. Conclusion: An interactive field assessment of a programmatic tool revealed the value of a systematic outbreak response plan with a standard definition of a tuberculosis outbreak, guidelines for communication and evaluation, and response steps. The assessment highlighted the importance of education and training for tuberculosis in low-incidence areas

Xpert® MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance.

BACKGROUND: Tuberculosis (TB) is the world's leading infectious cause of death. Extrapulmonary TB accounts for 15% of TB cases, but the proportion is increasing, and over half a million people were newly diagnosed with rifampicin-resistant TB in 2016. Xpert® MTB/RIF (Xpert) is a World Health Organization (WHO)-recommended, rapid, automated, nucleic acid amplification assay that is used widely for simultaneous detection of Mycobacterium tuberculosis complex and rifampicin resistance in sputum specimens. This Cochrane Review assessed the accuracy of Xpert in extrapulmonary specimens. OBJECTIVES: To determine the diagnostic accuracy of Xpert a) for extrapulmonary TB by site of disease in people presumed to have extrapulmonary TB; and b) for rifampicin resistance in people presumed to have extrapulmonary TB. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature (LILACS), Scopus, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number (ISRCTN) Registry, and ProQuest up to 7 August 2017 without language restriction. SELECTION CRITERIA: We included diagnostic accuracy studies of Xpert in people presumed to have extrapulmonary TB. We included TB meningitis and pleural, lymph node, bone or joint, genitourinary, peritoneal, pericardial, and disseminated TB. We used culture as the reference standard. For pleural TB, we also included a composite reference standard, which defined a positive result as the presence of granulomatous inflammation or a positive culture result. For rifampicin resistance, we used culture-based drug susceptibility testing or MTBDRplus as the reference standard. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data, assessed risk of bias and applicability using the QUADAS-2 tool. We determined pooled predicted sensitivity and specificity for TB, grouped by type of extrapulmonary specimen, and for rifampicin resistance. For TB detection, we used a bivariate random-effects model. Recognizing that use of culture may lead to misclassification of cases of extrapulmonary TB as 'not TB' owing to the paucibacillary nature of the disease, we adjusted accuracy estimates by applying a latent class meta-analysis model. For rifampicin resistance detection, we performed univariate meta-analyses for sensitivity and specificity separately to include studies in which no rifampicin resistance was detected. We used theoretical populations with an assumed prevalence to provide illustrative numbers of patients with false positive and false negative results. MAIN RESULTS: We included 66 unique studies that evaluated 16,213 specimens for detection of extrapulmonary TB and rifampicin resistance. We identified only one study that evaluated the newest test version, Xpert MTB/RIF Ultra (Ultra), for TB meningitis. Fifty studies (76%) took place in low- or middle-income countries. Risk of bias was low for patient selection, index test, and flow and timing domains and was high or unclear for the reference standard domain (most of these studies decontaminated sterile specimens before culture inoculation). Regarding applicability, in the patient selection domain, we scored high or unclear concern for most studies because either patients were evaluated exclusively as inpatients at tertiary care centres, or we were not sure about the clinical settings.Pooled Xpert sensitivity (defined by culture) varied across different types of specimens (31% in pleural tissue to 97% in bone or joint fluid); Xpert sensitivity was > 80% in urine and bone or joint fluid and tissue. Pooled Xpert specificity (defined by culture) varied less than sensitivity (82% in bone or joint tissue to 99% in pleural fluid and urine). Xpert specificity was ≥ 98% in cerebrospinal fluid, pleural fluid, urine, and peritoneal fluid.Xpert testing in cerebrospinal fluidXpert pooled sensitivity and specificity (95% credible interval (CrI)) against culture were 71.1% (60.9% to 80.4%) and 98.0% (97.0% to 98.8%), respectively (29 studies, 3774 specimens; moderate-certainty evidence).For a population of 1000 people where 100 have TB meningitis on culture, 89 would be Xpert-positive: of these, 18 (20%) would not have TB (false-positives); and 911 would be Xpert-negative: of these, 29 (3%) would have TB (false-negatives).For TB meningitis, ultra sensitivity and specificity against culture (95% confidence interval (CI)) were 90% (55% to 100%) and 90% (83% to 95%), respectively (one study, 129 participants).Xpert testing in pleural fluidXpert pooled sensitivity and specificity (95% CrI) against culture were 50.9% (39.7% to 62.8%) and 99.2% (98.2% to 99.7%), respectively (27 studies, 4006 specimens; low-certainty evidence).For a population of 1000 people where 150 have pleural TB on culture, 83 would be Xpert-positive: of these, seven (8%) would not have TB (false-positives); and 917 would be Xpert-negative: of these, 74 (8%) would have TB (false-negatives).Xpert testing in urineXpert pooled sensitivity and specificity (95% CrI) against culture were 82.7% (69.6% to 91.1%) and 98.7% (94.8% to 99.7%), respectively (13 studies, 1199 specimens; moderate-certainty evidence).For a population of 1000 people where 70 have genitourinary TB on culture, 70 would be Xpert-positive: of these, 12 (17%) would not have TB (false-positives); and 930 would be Xpert-negative: of these, 12 (1%) would have TB (false-negatives).Xpert testing for rifampicin resistanceXpert pooled sensitivity (20 studies, 148 specimens) and specificity (39 studies, 1088 specimens) were 95.0% (89.7% to 97.9%) and 98.7% (97.8% to 99.4%), respectively (high-certainty evidence).For a population of 1000 people where 120 have rifampicin-resistant TB, 125 would be positive for rifampicin-resistant TB: of these, 11 (9%) would not have rifampicin resistance (false-positives); and 875 would be negative for rifampicin-resistant TB: of these, 6 (1%) would have rifampicin resistance (false-negatives).For lymph node TB, the accuracy of culture, the reference standard used, presented a greater concern for bias than in other forms of extrapulmonary TB. AUTHORS' CONCLUSIONS: In people presumed to have extrapulmonary TB, Xpert may be helpful in confirming the diagnosis. Xpert sensitivity varies across different extrapulmonary specimens, while for most specimens, specificity is high, the test rarely yielding a positive result for people without TB (defined by culture). Xpert is accurate for detection of rifampicin resistance. For people with presumed TB meningitis, treatment should be based on clinical judgement, and not withheld solely on an Xpert result, as is common practice when culture results are negative

Challenges of tuberculosis management in high and low prevalence countries in a mobile world

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.In this issue of the PCRJ, Bishara et al. 1 present a case report about the treatment of a pregnant woman with tuberculosis (TB). She had emigrated from a country with a high prevalence of TB to one with a lower prevalence. This presented a challenge to her physicians who were faced with identifying and treating close contacts who were also infected. This Perspective article explores in more depth some of the questions raised by this case report. It discusses the role of primary care physicians in low prevalence countries who can implement evidence-based screening programmes, it discusses effective strategies for the diagnosis and treatment of TB in countries with high TB prevalence, and it presents insights from medical anthropology that can help practitioners overcome the barriers to TB diagnosis, treatment and screening described in the case report

Stable and Metastable vortex states and the first order transition across the peak effect region in weakly pinned 2H-NbSe_2

The peak effect in weakly pinned superconductors is accompanied by metastable vortex states. Each metastable vortex configuration is characterized by a different critical current density J_c, which mainly depends on the past thermomagnetic history of the superconductor. A recent model [G. Ravikumar, et al, Phys. Rev. B 61, R6479 (2000)] proposed to explain the history dependent J_c postulates a stable state of vortex lattice with a critical current density J_c^{st}, determined uniquely by the field and temperature. In this paper, we present evidence for the existence of the stable state of the vortex lattice in the peak effect region of 2H-NbSe_2. It is shown that this stable state can be reached from any metastable vortex state by cycling the applied field by a small amplitude. The minor magnetization loops obtained by repeated field cycling allow us to determine the pinning and "equilibrium" properties of the stable state of the vortex lattice at a given field and temperature unambiguously. The data imply the occurence of a first order phase transition from an ordered phase to a disordered vortex phase across the peak effect.Comment: 20 pages, 10 figures. Corresponding author: S. Ramakrishna

British HIV Association guidelines for the management of tuberculosis in adults living with HIV 2019

The overall purpose of these guidelines is to help physicians manage adults with tuberculosis (TB)/human immunodeficiency virus (HIV) co‐infection. Recommendations for the treatment of TB in HIV‐positive adults are similar to those in HIV‐negative adults. Of note, the term “HIV” refers to HIV‐1 throughout these guidelines

A study of supercooling of the disordered vortex phase via minor hysteresis loops in 2H-NbSe_2

We report on the observation of novel features in the minor hysteresis loops in a clean crystal of NbSe_2 which displays a peak effect. The observed behavior can be explained in terms of a supercooling of the disordered vortex phase while cooling the superconductor in a field. Also, the extent of spatial order in a flux line lattice formed in ascending fields is different from (and larger than) that in the descending fields below the peak position of the peak effect; this is attributed to unequal degree of annealing of the state induced by a change of field in the two cases.Comment: 5 pages of text + 6 figures, submitted to Phys. Rev.

Effect of pinning and driving force on the metastability effects in weakly pinned superconductors and the determination of spinodal line pertaining to order-disorder transition

We explore the effect of varying drive on metastability features exhibited by the vortex matter in single crystals of 2H-NbSe$_2$ and CeRu$_2$ with varying degree of random pinning. An optimal balance between the pinning and driving force is needed to view the metastability effects in typically weakly pinned specimen of low temperature superconductors. As one uses samples with larger pinning in order to differentiate the response of different metastable vortex states, one encounters a new phenomena, viz., the second magnetization peak (SMP) anomaly prior to the PE. Interplay between the path dependence in the critical current density and the non-linearity in the electromagnetic response determine the metastability effects seen in first and the third harmonic response of the ac susceptibility across the temperature regions of the SMP and the PE. The limiting temperature above which metastability effects cease can be conveniently located in the third harmonic data, and the observed behavior can be rationalized within the Beans Critical State model. A vortex phase diagram showing the different vortex phases for a typically weakly pinned specimen has been constructed via the ac susceptibility data in a crystal of 2H-NbSe$_2$ which shows the SMP and the PE anomalies. The phase space of coexisting weaker and stronger pinned regions has been identified. It can be bifurcated into two parts, where the order and disorder dominate, respectively. The former part continuously connects to the reentrant disordered vortex phase pertaining to the small bundle pinning regime, where the vortices are far apart, interaction effects are weak and the polycrystalline form of flux line lattice prevails.Comment: Submitted to the Special Volume on Vortex State Studies, Pramana J. Phy

Disordered Type-II Superconductors: A Universal Phase Diagram for Low-Tc_c Systems

A universal phase diagram for weakly pinned low-T$_c$ type-II superconductors is revisited and extended with new proposals. The low-temperature ``Bragg glass'' phase is argued to transform first into a disordered, glassy phase upon heating. This glassy phase, a continuation of the high-field equilibrium vortex glass phase, then melts at higher temperatures into a liquid. This proposal provides an explanation for the anomalies observed in the peak effect regime of 2H-NbSe$_2$ and several other low-T$_c$ materials which is independent of the microscopic mechanisms of superconductivity in these systems.Comment: 23 pages, 9 figure