Piloting Upfront Xpert MTB/RIF Testing on Various Specimens under Programmatic Conditions for Diagnosis of TB & DR-TB in Paediatric Population

India accounts for one-fifth of the global TB incidence. While the exact burden of childhood TB is not known, TB remains one of the leading causes of childhood mortality in India. Bacteriological confirmation of TB in children is challenging due to difficulty in obtaining quality specimens, in the absence of which diagnosis is largely based on clinical judgement. While testing multiple specimens can potentially contribute to higher proportion of laboratory confirmed paediatric TB cases, lack of high sensitivity tests adds to the diagnostic challenge. We describe here our experiences in piloting upfront Xpert MTB/RIF testing, for diagnosis of TB in paediatric population in respiratory and extra pulmonary specimens, as recently recommended by WHO.Xpert MTB/RIF testing was offered to all paediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities in the project areas covering 4 cities of India.Under this pilot project, 8,370 paediatric presumptive TB & presumptive DR-TB cases were tested between April and-November 2014. Overall, 9,149 specimens were tested, of which 4,445 (48.6%) were non-sputum specimens. Xpert MTB/RIF gave 9,083 (99.2%, CI 99.0-99.4) valid results. Of the 8,143 presumptive TB cases enrolled, 517 (6.3%, CI 5.8-6.9) were bacteriologically confirmed. TB detection rates were two fold higher with Xpert MTB/RIF as compared to smear microscopy. Further, a total of 60 rifampicin resistant TB cases were detected, of which 38 were detected among 512 presumptive TB cases while 22 were detected amongst 227 presumptive DR-TB cases tested under the project.Xpert MTB/RIF with advantages of quick turnaround testing-time, high proportion of interpretable results and feasibility of rapid rollout, substantially improved the diagnosis of bacteriologically confirmed TB in children, while simultaneously detecting rifampicin resistance

Levitation of a drop over a film flow

A vertical jet of water impinging on a horizontal surface produces a radial film flow followed by a circular hydraulic jump. We report a phenomenon where fairly large (1 mi) drops of liquid levitate just upstream of the jump on a thin air layer between the drop and the film flow. We explain the phenomenon using lubrication theory. Bearing action both in the air film and the water film seems to be necessary to support large drops. Horizontal support is given to the drop by the hydraulic jump. A variety of drop shapes is observed depending on the volume of the drop and liquid properties. We show that interaction of the forces due to gravity, surface tension, viscosity and inertia produces these various shapes

On the relationship between finger width, velocity, and fluxes in thermohaline convection

Double-diffusive finger convection occurs in many natural processes.The theories for double-diffusive phenomena that exist at present consider systems with linear stratification in temperature and salinity. The double-diffusive systems with step change in salinity and temperature are, however, not amenable to simple stability analysis. Hence factors that control the width of the finger, velocity, and fluxes in systems that have step change in temperature and salinity have not been understood so far. In this paper we provide new physical insight regarding factors that influence finger convection in two-layer double-diffusive system through two-dimensional numerical simulations. Simulations have been carried out for density stability ratios (R-rho) from 1.5 to 10. For each density stability ratio, the thermal Rayleigh number (Ra-T) has been systematically varied from 7x10(3) to 7x10(8). Results from these simulations show how finger width, velocity, and flux ratios in finger convection are interrelated and the influence of governing parameters such as density stability ratio and the thermal Rayleigh number. The width of the incipient fingers at the time of onset of instability has been shown to vary as Ra-T-1/3. Velocity in the finger varies as Ra(T)1/3/R-rho. Results from simulation agree with the scale analysis presented in the paper. Our results demonstrate that wide fingers have lower velocities and flux ratios compared to those in narrow fingers. This result contradicts present notions about the relation between finger width and flux ratio. A counterflow heat-exchanger analogy is used in understanding the dependence of flux ratio on finger width and velocity

Study of buoyant jets in natural ventilation of a model room

Buoyant jets in natural ventilation of a model room with water as the fluid medium have been studied. A constant heat flux has been maintained on the bottom surface of the room. The buoyancy causes flow to enter through the bottom opening and leave through the top opening. The shadowgraph technique is used for visualization. At the inlet, a negatively buoyant jet is observed, whereas a positively buoyant jet is observed at the outlet. The theoretical results for the centerline trajectories of these buoyant jets using both Gaussian and top-hat profiles are discussed considering the variation of the entrainment coefficient with the local Froude number and the variation of the spreading ratio of buoyancy to velocity profile with the distance from the source. The shape of the profiles is found to evolve from top-hat to Gaussian geometry

Removal of unwanted fluid

This work is concerned with the removal of unwanted fluid through the source-sink pair. The source consists of fluid issuing out of a nozzle in the form of a jet and the sink is a pipe that is kept some distance from the source pipe. Of concern is the percentage of source fluid sucked through the sink. The experiments have been carried in a large glass water tank. The source nozzle diameter is 6Â mm and the sink pipe diameter is either 10 or 20Â mm. The horizontal and vertical separations and angles between these source and sink pipes are adjustable. The flow was visualized using KMnO 4 dye, planer laser induced fluorescence and particle streak photographs. To obtain the effectiveness (that is percentage of source fluid entering the sink pipe), titration method is used. The velocity profiles with and without the sink were obtained using particle image velocimetry. The sink flow rate to obtain a certain effectiveness increase dramatically with lateral separation. The sink diameter and the angle between source and the sink axes don't influence effectiveness as much as the lateral separation

The Effect of Initial Momentum Flux on the Circular Hydraulic Jump

Earlier studies on the circular hydraulic jump have shown that the radial position of the hydraulic jump depends on the flow rate, gravity, and fluid viscosity. In this study, results from numerical simulations and experiments on circular hydraulic jumps are presented and through analysis, it is shown that the momentum flux is an additional controlling parameter in determining the jump location. Apart from the jump location, the variation of the film thickness with flow parameters is also obtained from experiments and numerical simulations. By including the dependence of the momentum flux and dissipation in the film along with other controlling parameters, the data on jump radius obtained from experiments and simulation (including the present study) covering a wide range of parameters reported in the literature can be collapsed on to a single curve

Modeling the Dynamics of the Mixed Layer in Solar Ponds

A new model is proposed to explain the Nielsen’s equilibrium condition. This model takes into account the effects of both turbulent entrainment and diffusion on the growth/erosion of the gradient zone. The existing turbulent entrainment model is modified to make it applicable near the equilibrium condition. The new model predictions indicate the dependence of the equilibrium condition on the mixed layer depth, apart from the salinity and temperature gradients in the gradient zone

Study of Submerged Jet for Suction of Fluid

This paper deals with the study of a submerged jet for the suction of unwanted fluid. This submerged jet is caused by the fluid coming out from a source. The presence of a sink in front of this source facilitates the suction of the fluid depending upon the source and sink flow rates, the axial and lateral separations of the source and sink, and the angle between the axes of the source and sink. The main purpose is the determination of the sink flow rate for 100% removal of the source fluid as a function of these parameters. The experiments have been carried using a source nozzle 6 mm in diameter and two sizes for the sink pipe diameter: 10 mm and 20 mm. The main diagnostics used are flow visualization using dye and particle image velocimetry (PIV). The dependence of the required suction flow rate to obtain 100% effectiveness on the suction tube diameter and angle is relatively weak compared to the lateral separation. DOI: 10.1115/1.4007266