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 METHODS: We did a systematic review and meta-analysis of published and unpublished studies reporting treatment outcomes for children with MDR tuberculosis.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

Elastic turbulence in two-dimensional Taylor-Couette flows

We report the onset of elastic turbulence in a two-dimensional Taylor-Couette geometry using numerical solutions of the Oldroyd-B model, also performed at high Weissenberg numbers with the program OpenFOAM. Beyond a critical Weissenberg number, an elastic instability causes a supercritical transition from the laminar Taylor-Couette to a turbulent flow. The order parameter, the time average of secondary-flow strength, follows the scaling law $\Phi \propto (\mathrm{Wi} -\mathrm{Wi}_c)^{\gamma}$ with $\mathrm{Wi}_c=10$ and $\gamma = 0.45$. The power spectrum of the velocity fluctuations shows a power-law decay with a characteristic exponent, which strongly depends on the radial position. It is greater than two, which we relate to the dimension of the geometry

Rana palustris

Number of Pages: 3Integrative BiologyGeological Science

Enhancing Decision Tree based Interpretation of Deep Neural Networks through L1-Orthogonal Regularization

One obstacle that so far prevents the introduction of machine learning models primarily in critical areas is the lack of explainability. In this work, a practicable approach of gaining explainability of deep artificial neural networks (NN) using an interpretable surrogate model based on decision trees is presented. Simply fitting a decision tree to a trained NN usually leads to unsatisfactory results in terms of accuracy and fidelity. Using L1-orthogonal regularization during training, however, preserves the accuracy of the NN, while it can be closely approximated by small decision trees. Tests with different data sets confirm that L1-orthogonal regularization yields models of lower complexity and at the same time higher fidelity compared to other regularizers.Comment: 8 pages, 18th IEEE International Conference on Machine Learning and Applications (ICMLA) 201

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

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