Reducing the Number of Sputum Samples Examined and Thresholds for Positivity: An Opportunity to Optimise Smear Microscopy.

SETTING: Urban health clinic, Nairobi. OBJECTIVE: To evaluate the impact on tuberculosis (TB) case detection and laboratory workload of reducing the number of sputum smears examined and thresholds for diagnosing positive smears and positive cases. DESIGN: In this prospective study, three Ziehl-Neelsen stained sputum smears from consecutive pulmonary TB suspects were examined blind. The standard approach (A), > or = 2 positive smears out of 3, using a cut-off of 10 acid-fast bacilli (AFB)/100 high-power fields (HPF), was compared with approaches B, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3, one of which is > or = 10 AFB/100 HPF; C, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3; D, > or = 1 positive smear (> or = 10 AFB/100 HPF) out of 2; and E, > or = 1 positive smear (> or = 4 AFB/100 HPF) out of 2. The microscopy gold standard was detection of at least one positive smear (> or = 4 AFB/100 HPF) out of 3. RESULTS: Among 644 TB suspects, the alternative approaches detected from 114 (17.7%) (approach B) to 123 cases (19.1%) (approach E) compared to 105 cases (16.3%) for approach A (P < 0.005). Sensitivity ranged between 82.0% (105/128) for A and 96.1% (123/128) for E. The single positive smear approaches reduced the number of smears by 36% compared to approach A. CONCLUSION: Reducing the number of specimens and the positivity threshold to define a positive case increased the sensitivity of microscopy and reduced laboratory workload

Added value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.

SETTING: Bleach sedimentation is a method used to increase the diagnostic yield of sputum microscopy for countries with a high prevalence of human immunodeficiency virus (HIV) infection and limited resources. OBJECTIVES: To compare the relative cost-effectiveness of different microscopy approaches in diagnosing tuberculosis (TB) in Kenya. METHODS: An analytical decision tree model including cost and effectiveness measures of 10 combinations of direct (D) and overnight bleach (B) sedimentation microscopy was constructed. Data were drawn from the evaluation of the bleach sedimentation method on two specimens (first on the spot [1] and second morning [2]) from 644 TB suspects in a peripheral health clinic. Incremental cost per smear-positive detected case was measured. Costs included human resources and materials using a micro-costing evaluation. RESULTS: All bleach-based microscopy approaches detected significantly more cases (between 23.3% for B1 and 25.9% for B1+B2) than the conventional D1+D2 approach (21.0%). Cost per tested case ranged between respectively euro 2.7 and euro 4.5 for B1 and B1+D2+B2. B1 and B1+B2 were the most cost-effective approaches. D1+B2 and D1+B1 were good alternatives to avoid using approaches exclusively based on bleach sedimentation microscopy. CONCLUSIONS: Among several effective microscopy approaches used, including sodium hypochlorite sedimentation, only some resulted in a limited increase in the laboratory workload and would be most suitable for programmatic implementation

XMM-Newton observations of the ultra-compact binary RX J1914+24

We present XMM–Newton observations of the 569-s-period system RX J1914+24 (V407 Vul). This period is believed to represent the binary orbital period making it an ultracompact binary system. By comparing the phase of the rise to maximum X-ray flux at various epochs (this includes observations made using ROSAT, ASCA and Chandra) we find that the system is spinning up at a rate of 3.17 ± 0.07 × 10−12 s s−1. We find that the spectra soften as the X-ray flux declines towards the off-phase of the 569-s period. Further, the spectra are best fitted by an absorbed blackbody component together with a broad emission feature around 0.59 keV. This emission feature is most prominent at the peak of the on-phase. We speculate on its origin

Feedback from massive stars at low metallicities : MUSE observations of N44 and N180 in the Large Magellanic Cloud

Accepted for publication in MNRAS, 27 pages, 21 figuresWe present MUSE integral field data of two HII region complexes in the Large Magellanic Cloud (LMC), N44 and N180. Both regions consist of a main superbubble and a number of smaller, more compact HII regions that formed on the edge of the superbubble. For a total of 11 HII regions, we systematically analyse the radiative and mechanical feedback from the massive O-type stars on the surrounding gas. We exploit the integral field property of the data and the coverage of the HeII$\lambda$5412 line to identify and classify the feedback-driving massive stars, and from the estimated spectral types and luminosity classes we determine the stellar radiative output in terms of the ionising photon flux $Q_{0}$. We characterise the HII regions in terms of their sizes, morphologies, ionisation structure, luminosity and kinematics, and derive oxygen abundances via emission line ratios. We analyse the role of different stellar feedback mechanisms for each region by measuring the direct radiation pressure, the pressure of the ionised gas, and the pressure of the shock-heated winds. We find that stellar winds and ionised gas are the main drivers of HII region expansion in our sample, while the direct radiation pressure is up to three orders of magnitude lower than the other terms. We relate the total pressure to the star formation rate per unit area, $\Sigma_{SFR}$, for each region and find that stellar feedback has a negative effect on star formation, and sets an upper limit to $\Sigma_{SFR}$ as a function of increasing pressure.Peer reviewe

Performance of LED-Based Fluorescence Microscopy to Diagnose Tuberculosis in a Peripheral Health Centre in Nairobi.

Sputum microscopy is the only tuberculosis (TB) diagnostic available at peripheral levels of care in resource limited countries. Its sensitivity is low, particularly in high HIV prevalence settings. Fluorescence microscopy (FM) can improve performance of microscopy and with the new light emitting diode (LED) technologies could be appropriate for peripheral settings. The study aimed to compare the performance of LED-FM versus Ziehl-Neelsen (ZN) microscopy and to assess feasibility of LED-FM at a low level of care in a high HIV prevalence country

An Optimal Linear Time Algorithm for Quasi-Monotonic Segmentation

Monotonicity is a simple yet significant qualitative characteristic. We consider the problem of segmenting a sequence in up to K segments. We want segments to be as monotonic as possible and to alternate signs. We propose a quality metric for this problem using the l_inf norm, and we present an optimal linear time algorithm based on novel formalism. Moreover, given a precomputation in time O(n log n) consisting of a labeling of all extrema, we compute any optimal segmentation in constant time. We compare experimentally its performance to two piecewise linear segmentation heuristics (top-down and bottom-up). We show that our algorithm is faster and more accurate. Applications include pattern recognition and qualitative modeling.Comment: This is the extended version of our ICDM'05 paper (arXiv:cs/0702142

XMM-Newton observations of the eclipsing polar EP Dra

We present XMM-Newton observations of the eclipsing polar EP Dra which cover nearly 3 binary orbital cycles. The X-ray and UV data show evidence for a prominent dip before the eclipse which is due to the accretion stream obscuring the accretion region. The dip ingress is rapid in hard X-rays suggesting there is a highly collimated core of absorption. We find that a different level of absorption column density is required to match the observed count rates in different energy bands. We propose that this is due to the fact that different absorption components should be used to model the reprocessed X-rays, the shocked X-ray component and the UV emission and explore the affect that this has on the resulting fits to the spectrum. Further, there is evidence that absorption starts to obscure the softer X-rays shortly after the onset of the bright phase. This suggests that material is threaded by an unusually wide range of magnetic field lines, consistent with the suggestion of Bridge et al. We find that the period is slightly greater than that determined by Schwope & Mengel.Comment: Accepted for publication MNRAS, 6 page