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Background Timika scoring system is a radiographic grading tool, widely employed for grading the severity of tuberculosis (TB). We evaluated the predictive accuracy of this tool for adverse treatment outcomes among TB patients in Indian setting. Methods We undertook a longitudinal analysis of cohort data under the RePORT-India consortium. Cohort having participants with active pulmonary TB were included. CXRs were independently scored by chest physicians. Timika scoring system had a total score of 140. The predictive nature of the tool was assessed using the ROC analysis. Results Around 364 laboratory confirmed TB patients were enrolled. The mean (SD) of overall Timika score was 62.3 (24.9). Sputum conversion was achieved among 218/260 (83.8%) patients available at end of intensive phase. AUC for Timika score was 0.53 (95% CI: 0.43–0.63) and for percent lung affected, was 0.56 (95% CI: 0.46–0.65). Unfavorable treatment outcome was observed among 67/287 (23.3%) at the end of continuation phase. AUC for percent lung affected was 0.62 (95% CI: 0.54–0.70) and for Timika score was 0.59 (95% CI: 0.51–0.67). Conclusion Both Timika scoring system and percent lung affected had poor predictive accuracy, highlighting the inability of a single CXR scoring system to predict the treatment outcome in Indian setting.

Background Undernutrition is the leading risk factor for tuberculosis (TB) globally. Its impact on treatment outcomes is poorly defined. Methods We conducted a prospective cohort analysis of adults with drug-sensitive pulmonary TB at 5 sites from 2015–2019. Using multivariable Poisson regression, we assessed associations between unfavorable outcomes and nutritional status based on body mass index (BMI) nutritional status at treatment initiation, BMI prior to TB disease, stunting, and stagnant or declining BMI after 2 months of TB treatment. Unfavorable outcome was defined as a composite of treatment failure, death, or relapse within 6 months of treatment completion. Results Severe undernutrition (BMI Conclusions Premorbid undernutrition, undernutrition at treatment initiation, lack of BMI increase after intensive therapy, and severe stunting are associated with unfavorable TB treatment outcomes. These data highlight the need to address this widely prevalent TB comorbidity. Nutritional assessment should be integrated into standard TB care.

While researchers have found a link between childhood maltreatment and language difficulties, the underlying mechanisms remain unclear and replication across the literature is inconsistent.To conduct a systematic review examining the methodological inconsistencies related to studies' samples construction, maltreatment measurement, and language outcomes using a language acquisition theory-based approach.Using the PRISMA framework, a literature search was conducted across five databases to identify studies that have investigated the effects of maltreatment on the language dimensions of vocabulary and grammar. Data were extracted for participant and maltreatment characteristics.Fifty articles were reviewed. The results revealed: 1) maltreated children performed consistently below peers on grammar but not vocabulary assessments, 2) disproportionate use of vocabulary assessments, 3) considerable variability on participant characteristics and limited multidimensional measurement of maltreatment exposure, and 4) only nine studies analyzed the relationship between a maltreatment dimension (e.g., type, severity) and language.Based on the results of this review, we propose three calls to action: 1) more language acquisition research in the child maltreatment field, 2) specificity when constructing samples with maltreated children, and 3) comprehensive and multidimensional maltreatment measurement. Implications for education were examined.

Children with maltreatment histories demonstrate weaker reading abilities compared to their peers. However, the differential processes driving this effect remain unclear. Prior studies focused on social and behavioral factors explaining this effect, yet reading research has shown that one's ability to comprehend written text is driven by a set of underlying dynamic and interactive cognitive abilities.This systematic review sought to understand what theoretical or conceptual frameworks researchers cited as guiding their studies, what reading processes and abilities were studied as outcomes, how reading processes or abilities were measured, and what constructs were included to help understand the relationship between maltreatment and reading.Three databases were searched for empirical peer-reviewed journal articles. Articles retained using inclusion and exclusion criteria were coded based on their sample characteristics, reference to theoretical or conceptual frameworks, reading processes and abilities measured, and included predictors of reading. Procedures were documented using the reporting items for systematic reviews and meta-analyses (PRISMA) statement (Moher et al., 2009).Twenty-seven studies were included in the final systematic review. Those that discussed theoretical or conceptual frameworks focused on the social and behavioral predictors of reading. Many studies (51.9 %) examined effects of maltreatment on reading achievement, rather than specific reading processes or abilities. Most studies (92.6 %) used at least one standardized reading measure. However, only four studies included cognitive abilities as potential predictor variables.Future research could benefit from investigating specific cognitive and reading-related processes, using measures to examine specific reading processes leading to breakdowns in reading achievement, and incorporation of reading theories to drive research questions and methods.

Molecular epidemiologic studies have shown that the dynamics of tuberculosis transmission varies geographically. We sought to determine which strains of Mycobacterium tuberculosis (MTB) were infecting household contacts (HHC), and which were causing clusters of tuberculosis (TB) disease in Vitoria-ES, Brazil. A total of 741 households contacts (445 TST +) and 139 index cases were characterized according to the proportion of contacts in each household that had a tuberculin skin test positive: low (LT) (≤40% TST+), high (HT) (≥70% TST+) and (40–70% TST+) intermediate (IT) transmission. IS 6110 -RFLP and spoligotyping analysis were performed only 139 MTB isolates from index cases and 841 community isolates. Clustering occurred in 45% of the entire study population. There was no statistically significant association between MTB household transmission category and clustering. Within the household study population, the proportion of clusters in HT and LT groups was similar (31% and 36%, respectively; p = 0.82). Among index cases isolates associated with households demonstrating TST conversion, the frequency of unique pattern genotypes was higher for index cases of the LT compared to HT households (p = 0.03). We concluded that clusters and lineages associated with MTB infection in HT households had no proclivity for increased transmission of TB in the community.

RePORT International is a collaborative research network of investigators from multiple countries and institutions with the goal of establishing a bio-repository of specimens and clinical data for the study of active TB and latent TB infection (LTBI). During the first meeting of RePORT International in Boston, Massachusetts, the results of research pertinent to TB control and eradication were presented, including advances in the research of Mycobacterium tuberculosis (MTB) persistence and drug resistance, TB diagnostics, drug and vaccine development.

Summary Objectives In the USA, tuberculosis disease rates are highest in older adults. Diagnostic testing for latent tuberculosis infection (LTBI) has not been evaluated carefully in this group. The aim of this study was to define the relationship between tuberculin skin test (TST) results, T-SPOT. TB results, and T-cell responses to Mycobacterium tuberculosis antigens. Methods Long-term care facility residents with known prior TST results (positive or negative) were retested with TSTs and T-SPOT. TB . Prior exposure to M. tuberculosis was assessed by quantifying T-cell activation to mycobacterial antigens in vitro. Results The median age of the 37 participants was 77 years (range 57–98 years). Among 18 participants with a prior positive TST, three (16.7%) had a negative TST when retested (TST reversion); two had a negative T-SPOT. TB . Of the 15 who were historically and currently TST-positive, four (26.7%) had a negative T-SPOT. TB and one (6.7%) had a borderline result. Percentages of CD4+ T-cells responding to mycobacterial antigens were higher in participants with positive TST and T-SPOT. TB (18.2%) compared to those with a positive TST but negative T-SPOT. TB (6.4%, p =0.16) and negative TST and T-SPOT. TB (5.9%, p Conclusions LTBI testing in older adults is complicated by TST reversion and TST-positive/T-SPOT. TB -negative discordance, which may reflect clearance of infection or waning immunity.

Host- and pathogen-specific factors interplay with the environment in a complex fashion to determine the outcome of infection with Mycobacterium tuberculosis (Mtb), resulting in one of three possible outcomes: cure, latency or active disease. Although much remains unknown about its pathophysiology, latent tuberculosis infection (LTBI) defined by immunologic evidence of Mtb infection is a continuum between self-cure and asymptomatic, yet active tuberculosis (TB) disease. Strain virulence, intensity of exposure to the index case, size of the bacterial inoculum, and host factors such as age and co-morbidities, each contribute to where one settles on the continuum. Currently, the diagnosis of LTBI is based on reactive tuberculin skin testing (TST) and/or a positive interferon-gamma release assay (IGRA). Neither diagnostic test reflects the activity of the infectious focus or the risk of progression to active TB. This is a critical shortcoming, as accurate and efficient detection of those with LTBI at higher risk of progression to TB disease would allow for provision of targeted preventive therapy to those most likely to benefit. Host biomarkers may prove of value in stratifying risk of development of TB. New guidelines are required for interpretation of discordance between TST and IGRA, which may be due in part to a lack of stability (that is reproducibility) of IGRA or TST results or to a delay in conversion of IGRA to positivity compared to TST. In this review, the authors elaborate on the definition, diagnosis, pathophysiology and natural history of LTBI, as well as promising methods for better stratifying risk of progression to TB. The review is centered on the human host and the clinical and epidemiologic features of LTBI that are relevant to the development of new and improved diagnostic tools.

We analyze how temporal variability in local demography and dispersal combine to affect the rate of spread of an invading species. Our model combines state-structured local demography (specified by an integral or matrix projection model) with general dispersal distributions that may depend on the state of the individual or its parent, and it allows very general patterns of stationary temporal variation in both local demography and in the frequency and distribution of dispersal distances. We show that expressions for the asymptotic spread rate and its sensitivity to parameters, that have been derived previously for less general models, continue to hold. Using these results, we show that random temporal variability in dispersal can accelerate population spread. Demographic variability can further accelerate spread if it is positively correlated with dispersal variability, for example if high-fecundity years are also years in which juveniles tend to settle further away from their parents. A simple model for the growth and spread of patches of an invasive plant (perennial pepperweed, Lepidium latifolium) illustrates these effects and shows that they can have substantial impacts on the predicted speed of an invasion wave. Temporal variability in dispersal has gotten very little attention in both the theoretical and empirical literatures on invasive species spread. Our results suggest that this needs to change., Final version accepted for publication in Theoretical Population Biology, special issue "Developments in structured models: construction, analysis and inference"

Advances in health information technology provide significant opportunities for improvements in surgical patient safety. The adoption and use of electronic health records can enhance communication along the surgical spectrum of care. Bar coding and radiofrequency identification technology are strategies to prevent retained surgical sponges and for tracking the operating room supply chain. Computerized intraoperative monitoring systems can improve the performance of the operating room team. Automated data registries collect patient information to be analyzed and used for surgical quality improvement.

In this paper we use information theory techniques on time series of abundances to determine the topology of a food web. At the outset, the food web participants (two consumers, two resources) are known; in addition we know that each consumer prefers one of the resources over the other. However, we do not know which consumer prefers which resource, and if this preference is absolute (i.e., whether or not the consumer will consume the non-preferred resource). Although the consumers and resources are identified at the beginning of the experiment, we also provide evidence that the consumers are not resources for each other, and the resources do not consume each other. We do show that there is significant mutual information between resources; the model is seasonally forced and some shared information between resources is expected. Similarly, because the model is seasonally forced, we expect shared information between consumers as they respond to the forcing of the resources. The model that we consider does include noise, and in an effort to demonstrate that these methods may be of some use in other than model data, we show the efficacy of our methods with decreasing time series size; in this particular case we obtain reasonably clear results with a time series length of 400 points. This approaches ecological time series lengths from real systems.

Unit cell parameters were measured for the solid solutions Pd(Sb), Pd(Bi) and Pt(Sb) in the whole range of homogeneity. The composition dependence of the average atomic volume was investigated for the binary systems Pd–Sb and Pd–Bi. For the solid solutions Pd(Sb) and Pd(Bi), the partial atomic volumes of antimony and bismuth were determined. They are compared with the partial atomic volumes of the 4d (Ag⋯Te) and 5d (Au⋯Pb) elements measured in the palladium-based solid solutions. The increase in the partial atomic volume for the 4d elements Ag and Sb amounts to 16.3%, for the analogous heavy elements Au and Bi to 26.1%.

A method to generate strongly polarized nuclear spins in solution has been developed, using Dynamic Nuclear Polarization (DNP) at a temperature of 1.2 K, and at a field of 3.354 T, corresponding to an electron spin resonance frequency of 94 GHz. Trityl radicals are used to directly polarize C-13 and other low-gamma nuclei. Subsequent to the DNP process, the solid sample is dissolved rapidly with a warm solvent to create a solution of molecules with highly polarized nuclear spins. Two main applications are proposed: high-resolution liquid state NMR with enhanced sensitivity, and the use of the hyper-polarized solution as an MR imaging agent. (C) 2003 Elsevier B.V. All rights reserved.

Unit cell parameters were measured for the binary palladium and platinum-rich alloys containing the A 4 early transition metals (titanium, zirconium and hafnium). The composition dependence of the average atomic volume was investigated for the whole composition range of these binary systems. For the palladium and platinum-rich portions, the partial atomic volume and the partial molar enthalpy of formation are discussed. Both the volumetric and the thermodynamic quantities reveal a strong bond energy between atoms of the heavy A 4 transition metals (zirconium and hafnium) and the heavy A 10 transition metals (palladium and platinum).

To increase the analytical tractability of lattice stochastic spatial population models, several approximations have been developed. The pair-edge approximation is a moment-closure method that is effective in predicting persistence criteria and invasion speeds on a homogeneous lattice. Here we evaluate the effectiveness of the pair-edge approximation on a spatially heterogeneous lattice in which some sites are unoccupiable, or "dead". This model has several possible interpretations, including a spatial SIS epidemic model, in which some sites are occupied by immobile host-species individuals while others are empty. We find that, as in the homogeneous model, the pair-edge approximation is significantly more accurate than the ordinary pair approximation in determining conditions for persistence. However, habitat heterogeneity decreases invasion speed more than is predicted by the pair-edge approximation, and the discrepancy increases with greater clustering of "dead" sites. The accuracy of the approximation validates the underlying heuristic picture of population spread and therefore provides qualitative insight into the dynamics of lattice models. Conversely, the situations where the approximation is less accurate reveals limitations of pair approximation in the presence of spatial heterogeneity.

The previously reported, ordered low-temperature NiAs/Ni2In-type phase Ni1+xSn comprises in the concentration range 0.35

Unit cell parameters and densities were measured for the terminal solid solutions of the late transition metals showing the fcc structure (α-Co, Rh, Ir, Ni, Pd, Pt) with boron and partly with carbon. Especially the solid solutions Pd(B) and Pd(C) were investigated because of the large homogeneity range up to the atomic fractions xfB=0.186 and xfC≃0.05, respectively. The unit cell parameter increases and the density decreases with increasing boron and carbon content. Comparison of the calculated and measured number of atoms in the Pd(B) and Pd(C) unit cells confirms the interstitial nature of both solid solutions. The difference between the measured dependence of the Pd–B shortest interatomic distances on the solute content and those calculated according to the hard sphere model indicates a distinct negative deviation from additivity of the pure form volumes. The chemical (electronic) interaction plays a more important role than the elastic interaction (characterized by a size factor) in the formation of solid solutions of metals with the interstitially dissolved metalloids H, B, C, N and O.

The unit cell parameters of the trihydride GdH3 (Pearson symbol hP24, space group P3c1, HoH3 type) were determined employing Guinier powder diffraction patterns. The structure of the interstitial compound GdH3 is formed by departing from a hexagonal close-packed substructure of gadolinium and by filling its tetrahedral and triangular atomic positions with hydrogen atoms. The occupation of interstitial atomic positions in the hexagonal close-packed structure causes lattice dilatation associated with a significant change of the axial ratio c/a. In the intermediate phases of the binary system Gd–H, the interatomic distance between gadolinium and hydrogen atoms, dGd–H, decreases with increasing hydrogen content; the shortest dGd–H distance was observed to occur in GdH3. A set of powder diffraction data was obtained for GdH3.

X-ray high-temperature powder diffraction investigations were made in situ on the aluminide TiAl 2 (Pearson symbol tI 24, space group I 4 1 / amd , HfGa 2 type) in the temperature range 20–763°C. The unit cell parameters and the unit cell volume increase linearly with temperature, whereas the axial ratio c / a hardly changes with temperature. Metallographical and X-ray powder diffraction investigations on the heat-treated and subsequently quenched alloys show that TiAl 2 is stable up to 1200°C. In the as-cast alloy TiAl 2 , a metastable orthorhombic modification TiAl 2 (m) has been observed ( oC 12, Cmmm , ZrGa 2 type). X-ray powder diffraction data for the stable TiAl 2 modification are presented.

Naturally occurring leprosy has been demonstrated in wild nine-banded armadillos (Dasypus novemcinctus ). This suggests a possible mode of transmission of human leprosy in regions where armadillo contact is prevalent.Our purpose was to study the possible relationship between armadillo exposure and Hansen's disease.One hundred one patients (67 men, 34 women) with established Hansen's disease seen in the Hansen's Disease Clinic in Houston, Texas, were questioned about their exposure to armadillos. These patients were divided into two groups: Asian (n = 32) and non-Asian (n = 69).Seventy-one percent of the non-Asian patients surveyed reported either direct or indirect armadillo exposure. None of the Asian patients reported armadillo exposure (P.001). Of the non-Asian patients, 75.4% had lepromatous disease versus 50.0% of the Asian patients (P.001). The average age at diagnosis for the non-Asian group with Hansen's disease in this study was 51 versus 38 years for the Asian group (P.001).Although it is yet to be determined whether direct transmission from the armadillo to human occurs, it is likely based on the high incidence of armadillo exposure in non-Asian patients with Hansen's disease in our study population that this animal acts as a reservoir for human disease. However, the Asian patients reporting no known armadillo exposure likely obtained the disease from person-to-person contact in their respective countries of origin where Hansen's disease has a much higher prevalence.

Objectives Laparoscopic adjustable gastric banding (LAGB) is a safe, controlled method for weight loss in the morbidly obese patient. Inversion or dislodgement of the port leads to difficulty with access for band adjustments and frequently requires reoperation. We report our experience with port fixation to the rectus sheath of the abdominal wall by using port/mesh fixation to prevent port site complications. Methods One hundred and ninety-one morbidly obese patients underwent LAGB between April 2002 and August 2005. The first group had ports fixed to the rectus fascia of the abdominal wall with a standard 4-point suture technique. The second group had ports sutured to a mesh, which was then tacked to the rectus sheath of the abdominal wall. Port site complications were analyzed over a 5-month to 40-month period and compared between the 2 groups. Intraoperative port fixation times were recorded for each technique. Results Thirty-nine patients in the suture fixation group encountered a 20.5% port site complication rate, with 10.3% of the ports becoming dislodged or inverted. The mesh/tack group consisted of 151 patients. The port site complication rate was 5.3%, with only a 1.3% rate of port dislodgement or inversion. The port dislodgement or inversion rates were significantly different between groups ( P = .0049). The average operative times for port insertion were 12 minutes for the sutured technique and 5 minutes for the mesh/tack technique. Conclusions The mesh/tack method of port fixation reduced the incidence of dislodgement and rotation in our patient population, which resulted in greater ease of access for adjustments. Furthermore, the mesh/tack technique is a quick, safe approach for port fixation through a small incision.

Unit cell parameters and macroscopic densities were measured for gadolinium-rich (xH 2/3) of the dihydride GdH2+x (defect CaF2 type). The experimentally determined values of the number of atoms in the unit cell are consistent with the results of earlier work on some dihydrides REH2+x isotypical with CaF2. It was concluded that for the hydrogen-rich compositions, the excess hydrogen atoms occupy the Wyckoff (octahedral) position (b) of the space group Fm3m, whereas for the gadolinium-rich compositions vacancies occur on the hydrogen sites (c). The gadolinium sites (a) remain occupied fully by gadolinium atoms in the homogeneity range of the gadolinium dihydride. A set of powder diffraction data was obtained for GdH2.