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 METHODS: We did a systematic review and meta-analysis of published and unpublished studies reporting treatment outcomes for children with MDR tuberculosis.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

Thermal X-Ray Pulses Resulting From Pulsar Glitches

The non-spherically symmetric transport equations and exact thermal evolution model are used to calculate the transient thermal response to pulsars. The three possible ways of energy release originated from glitches, namely the `shell', `ring' and `spot' cases are compared. The X-ray light curves resulting from the thermal response to the glitches are calculated. Only the `spot' case and the `ring' case are considered because the `shell' case does not produce significant modulative X-rays. The magnetic field ($\vec B$) effect, the relativistic light bending effect and the rotational effect on the photons being emitted in a finite region are considered. Various sets of parameters result in different evolution patterns of light curves. We find that this modulated thermal X-ray radiation resulting from glitches may provide some useful constraints on glitch models.Comment: 48 pages, 20 figures, submitted to Ap

Cavitation of the Ghon focus in an HIV-infected infant who acquired tuberculosis after the initiation of HAART

Tuberculosis immune reconstitution inflammatory syndrome (IRIS) may present as new or worsening cavitation. We present an HIV-infected infant in whom TB infection and subsequent cavitation of the Ghon focus appeared to coincide with immune reconstitution due to highly active antiretroviral therapy (HAART). TB-IRIS in response to infection that occurs after starting HAART has not previously been described

Viscous Effects on Impact Probes in a Subsonic Rarified Gas Flow

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

The UNO Aviation Monograph Series: Aviation Security: An Annotated Bibliography of Responses to the Gore Commission

This monograph is a companion to UNOAI Monograph 96-2, "The Image of Airport Security: An Annotated Bibliography," compiled in June 1996. The White House Commission on Aviation Safety and Security, headed by Vice President Al Gore, was formed as a result of the TWA Flight 800 crash in August 1996. The Commission's final report included 31 recommendations addressed toward aviation security. The recommendations were cause for security issues to be revisited in the media and by the aviation industry. These developments necessitated the need for an updated bibliography to review the resulting literature. Many of the articles were written in response to the recommendations made by the Gore Commission. "Aviation Security: An Annotated Bibliography of Responses to the Gore Commission" is the result of this need

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

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