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 METHODS: We did a systematic review and meta-analysis of published and unpublished studies reporting treatment outcomes for children with MDR tuberculosis.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

Exposing piaget's scheme: Empirical evidence for the ontogenesis of coordination in learning a mathematical concept

The combination of two methodological resources-natural-user interfaces (NUI) and multimodal learning analytics (MMLA)-is creating opportunities for educational researchers to empirically evaluate seminal models for the hypothetical emergence of concepts from situated sensorimotor activity. 76 participants (9-14 yo) solved tablet-based non-symbolic manipulation tasks designed to foster grounded meanings for the mathematical concept of proportional equivalence. Data gathered in task-based semi-structured clinical interviews included action logging, eye-gaze tracking, and videography. Successful task performance coincided with spontaneous appearance of stable dynamical gaze-path patterns soon followed by multimodal articulation of strategy. Significantly, gaze patterns included uncued non-salient screen locations. We present cumulative results to argue that these 'attentional anchors' mediated participants' problem solving. We interpret the findings as enabling us to revisit, support, refine, and elaborate on central claims of Piaget's theory of genetic epistemology and in particular his insistence on the role of situated motor-action coordination in the process of reflective abstraction

Eye-tracking the emergence of attentional anchors in a mathematics learning tablet activity

Little is known about micro-processes by which sensorimotor interaction gives rise to conceptual development. Per embodiment theory, these micro-processes are mediated by dynamical attentional structures. Accordingly this study investigated eye-gaze behaviors during engagement in solving tablet-based bimanual manipulation tasks designed to foster proportional reasoning. Seventy-six elementary- and vocational-school students (9-15 yo) participated in individual task-based clinical interviews. Data gathered included action-logging, eye-tracking, and videography. Analyses revealed the emergence of stable eye-path gaze patterns contemporaneous with first enactments of effective manipulation and prior to verbal articulations of manipulation strategies. Characteristic gaze patterns included consistent or recurring attention to screen locations that bore non-salient stimuli or no stimuli at all yet bore invariant geometric relations to dynamical salient features. Arguably, this research validates empirically hypothetical constructs from constructivism, particularly reflective abstraction

Constraining stochastic 3-D structural geological models with topology information using Approximate Bayesian Computation in GemPy 2.1

Acknowledgements. We would like to thank Total E&P UK in Aberdeen for funding this research. We also thank Fabian Stamm for providing the wonderful synthetic geomodel used in this paper. We are grateful for the constructive reviews from Ashton Krajnovich and an anonymous reviewer for helping us improve this manuscript.Peer reviewedPublisher PD

Influence of Hydrodynamic Interactions on the Kinetics of Colloidal Particle's Adsorption

The kinetics of irreversible adsorption of spherical particles onto a flat surface is theoretically studied. Previous models, in which hydrodynamic interactions were disregarded, predicted a power-law behavior $t^{-2/3}$ for the time dependence of the coverage of the surface near saturation. Experiments, however, are in agreement with a power-law behavior of the form $t^{-1/2}$. We outline that, when hydrodynamic interactions are considered, the assymptotic behavior is found to be compatible with the experimental results in a wide region near saturation.Comment: 4 pages, 1 figures, Phys. Rev. Lett. (in press

Thomas-Fermi Calculations of Atoms and Matter in Magnetic Neutron Stars II: Finite Temperature Effects

We present numerical calculations of the equation of state for dense matter in high magnetic fields, using a temperature dependent Thomas-Fermi theory with a magnetic field that takes all Landau levels into account. Free energies for atoms and matter are also calculated as well as profiles of the electron density as a function of distance from the atomic nucleus for representative values of the magnetic field strength, total matter density, and temperature. The Landau shell structure, which is so prominent in cold dense matter in high magnetic fields, is still clearly present at finite temperature as long as it is less than approximately one tenth of the cyclotron energy. This structure is reflected in an oscillatory behaviour of the equation of state and other thermodynamic properties of dense matter and hence also in profiles of the density and pressure as functions of depth in the surface layers of magnetic neutron stars. These oscillations are completely smoothed out by thermal effects at temperatures of the order of the cyclotron energy or higher.Comment: 37 pages, 17 figures included, submitted to Ap

Adsorption of colloidal particles in the presence of external field

We present a new class of sequential adsorption models in which the adsorbing particles reach the surface following an inclined direction (shadow models). Capillary electrophoresis, adsorption in the presence of a shear or on an inclined substrate are physical manifestations of these models. Numerical simulations are carried out to show how the new adsorption mechanisms are responsible for the formation of more ordered adsorbed layers and have important implications in the kinetics, in particular modifying the jamming limit.Comment: LaTex file, 3 figures available upon request, to appear in Phys.Rev.Let

How much do you want to learn? High-school students' willingness to invest effort in valenced feedback-learning tasks

High-school students decide in which tasks to invest their cognitive effort on a daily basis. At school, such decisions often relate to feedback-learning situations (e.g., whether or not to do homework exercises). To investigate how willing high-school students are to invest their cognitive effort in such situations, we administered in this preregistered study a feedback-learning task in combination with a cognitive effort-discounting task – a paradigm to quantify willingness to invest effort. We did so to a large sample (N = 195) from average educational backgrounds in an ecologically valid setting (a school class). We specifically tested whether high-school students discounted their effort in feedback-learning tasks, which proved to be the case, and whether this discounting was differentially affected by positive and negative feedback, which proved not to be the case. We also found that learning was unaffected by feedback valence, except that students learned better from positive than from negative feedback when high effort was required. These results imply that in a school setting, where feedback learning is common, high-school students are less willing to invest cognitive effort in more effortful tasks irrespective of feedback valence, and that positive feedback can aid learning when high effort is required. We provide several recommendations as to how our proposed combination of feedback learning and effort discounting could be used to understand and improve students' academic motivation. Educational relevance statement: High school students sometimes struggle with motivation for learning, at least partly because of low willingness to invest their effort. By investigating high-school students' willingness to invest effort for learning within an educational context, we aim to enhance understanding of this decision-making process in high-school students. Our results indicate that in a school setting, where feedback learning is common, high-school students are less willing to invest cognitive effort in more effortful tasks irrespective of whether they receive positive or negative feedback, but that positive feedback can aid learning when learning tasks require high effort. These results imply that positive feedback may reduce the costs of learning or increase its benefits for difficult tasks.</p