2,464 research outputs found

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

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    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 METHODS: We did a systematic review and meta-analysis of published and unpublished studies reporting treatment outcomes for children with MDR tuberculosis.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

    Viscous Effects on Impact Probes in a Subsonic Rarified Gas Flow

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    The problem of time response of pressure gaging systems used with low density flows has been discussed in Ref ]4, and the effect of outgassing on pressure magnitudes was indicated in the same reference. Briefly, gases or vapors adhering to the internal walls of the pressure gaging system behave like gas sources and produce a pressure rise in the gage system which has no relation to the external flow. The effect can also occur in the reverse direction, with "in-gassing" or the action of an effective sink in the gage system as gases entering through the probe orifice are adsorbed to the walls. For given surface conditions, the magnitude of the pressure error to be expected due to out-gassing depends on the dimensions of the probe system. In the present tests, it was desirable to use the smallest possible probe to yield the lowest possible Reynolds number. The lower limit on size was fixed by outgassing effects, evaluated by the following procedure. 2.0 PROCEDURE The pumping system was adjusted to give a pressure, measured at the reservoir, of 9 microns Hg with no flow into the wind tunnel. The upstream metering valve was then opened and the air flow rate adjusted to give a pressure of 100 microns in the reservoir under steady flow conditions, The pressure read by one of the impact tubes, inserted into the flow, was measured. The upstream metering valve was then closed rapid)y, and the reservoir pressure, p0, and the impact probe pressure, Pj, were measured simultaneously at definite time intervals. Another probe was inserted into the flow and the procedure repeated, until the pressure-time data had been obtained for each probe investigated. The results for a series of tests Involving probe Nos.l, 2 and 3 are shown on HYD 2616 300 RESULTS From HYD 2616, It is clear that the smallest probe (No.3) requires the longest time to reach equilibrium. After a sufficient time has elapsed (about 180 seconds), this probe read the same, within the accuracy of measurement, as the other two, When a similar experiment was performed utilizing a probe which was one-half the size of probe No.2, it indicated a pressure, after 180 seconds, which was almost 10 microns Hg higher than the other probes. Accordingly, only probe Nos. 1, 2, 3 and 4 were employed in the experiments, and a time of at least 180 seconds was allowed to elapse between a change of setting and the reading of the instruments

    Boundary Layer Effect on the Surface Pressure of an Infinite Cone in Supersonic Flow

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    The theory of Taylor and Maccoll (Ref,1) gives the surface pressure on an infinite cone in supersonic flow as a function of the cone vertex angle and the free stream Mach number and static pressure for a gas of vanishing viscosity. When a slender conical probe is used together with an impact pressure probe to determine the static pressure and Mach number in a low density gas stream, it is desirable to have some theoretical estimate of the effect of viscous boundary layer on the probe readings. Theoretical and experimental results with respect to impact probes have been presented in Refs. 5 and 6. A simple approximation for a conical probe based on linearized supersonic flow and compressible boundary layer theory is presented here

    Quantum Drag Forces on a Sphere Moving Through a Rarefied Gas

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    As an application of quantum fluid mechanics, we consider the drag force exerted on a sphere by an ultra-dilute gas. Quantum mechanical diffraction scattering theory enters in that regime wherein the mean free path of a molecule in the gas is large compared with the sphere radius. The drag force is computed in a model specified by the ``sticking fraction'' of events in which a gaseous molecule is adsorbed by the spherical surface. Classical inelastic scattering theory is shown to be inadequate for physically reasonable sticking fraction values. The quantum mechanical scattering drag force is exhibited theoretically and compared with experimental data.Comment: 5 pages no figure
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