Elaboração e validação de um instrumento de avaliação da transferência do Tratamento Diretamente Observado da tuberculose segundo a perspectiva de profissionais de saúde de nível médio e superior (ATP-IINFOC-TB)

Compreendendo a tuberculose enquanto problema de saúde pública, desde meados dos anos 1990 a Organização Mundial da Saúde recomenda ações de controle da doença, dentre estas a Directly Observed Treatment Short-Course (DOTS) que, junto às demais recomendações, é transferida e executada em diferentes cenários, sendo essa transferência merecedora de atenção e aprofundamento, o que deve ocorrer por meio da utilização de métodos válidos e confiáveis. Trata-se de um estudo metodológico, cujo objetivo é elaborar e validar um instrumento voltado à avaliação da transferência da política do Tratamento Diretamente Observado, segundo a perspectiva de profissionais de saúde, por meio das dimensões \"Informação\", \"Conhecimento\" e \"Inovação\". O estudo foi realizado em três fases, a saber: validação semântica, primeira fase do estudo de campo e segunda fase do estudo de campo. A validação semântica contou com 24 profissionais; a primeira fase do estudo de campo, com 101 profissionais; e a segunda fase do estudo de campo, com 401 profissionais. Na validação semântica, o instrumento foi ajustado segundo as sugestões dos entrevistados, tendo ocorrido também a retirada de dois itens dos 49 inicialmente propostos. Na primeira fase do estudo de campo, o instrumento não apresentou efeito floor and ceiling e foram retirados 8 itens com carga fatorial < 0,30 na Análise Fatorial Exploratória. O instrumento apresentou um bom alfa de Cronbach (?=0,87), e a dimensão \"Conhecimento\" apresentou alfa baixo (?=0,645). Na segunda fase do estudo de campo, o efeito floor and ceiling manteve- se ausente, com baixo coeficiente de correlação linear de Pearson (r), baixo ajuste (55%) e baixo alfa de Cronbach (?=0,61) para a dimensão \"Conhecimento\", tendo as dimensões \"Informação\" e \"Inovação\" atingido valores aceitáveis. Para o instrumento como um todo, o Alfa de Cronbach foi de 0,872. O KMO e o Teste de Esfericidade de Bartlett foram satisfatórios, permitindo a Análise Fatorial Confirmatória. Entretanto, identificou-se baixo valor de ajuste do modelo no CFI e RMSEA (0,576 e 0,088, respectivamente), com uma baixa correlação entre as dimensões propostas. Conclui-se que o instrumento elaborado é capaz de avaliar a transferência do TDO segundo a perspectiva de profissionais de saúde de nível médio e superior de forma unidimensional, sem a utilização das três dimensões inicialmente propostas

TB/HIV, the connection : what health care workers should know.

"February 1989."

Poverty and the economic effects of TB in rural China

OBJECTIVE: To investigate the economic effects of illness on individual tuberculosis (TB) cases in rural China and to use a case-control study to show a strong TB-poverty link. SETTING: In 2002-2004 we studied 160 new smear-positive pulmonary tuberculosis (PTB) cases and 320 age- and sex-matched controls living in neighbouring houses in four rural counties of Henan Province. DESIGN: Cases and controls were interviewed 1-3 months after patients were diagnosed. We used matched multivariate logistic regression to compare cases with controls for poverty status using household income, household assets and relative wealth within the village. We conducted follow-up interviews of patients 10-12 months later to assess economic effects by collecting data on treatment costs, income losses, coping strategies and treatment completion. RESULTS: Poverty is strongly associated with TB incidence even after controlling for smoking and other risk factors. Excluding income losses, direct out-of-pocket treatment costs (medical and non-medical) accounted for 55.5 % of average annual household income, and most TB cases fell into heavy debt. The DOTS cure rate was 91 %. When DOTS was incomplete or not done, mortality was high. CONCLUSIONS: Poverty is both a cause and a devastating outcome of TB. Ongoing poverty reduction schemes in China must also include reducing TB.

PLGA microspheres for the delivery of a novel subunit TB vaccine

Biodegradable poly(dl-lactide-co-glycolide) microspheres were prepared using a modified double emulsion solvent evaporation method for the delivery of the subunit tuberculosis vaccine (Ag85B-ESAT-6), a fusion protein of the immunodominant antigens 6-kDa early secretory antigenic target (ESAT-6) and antigen 85B (Ag85B). Addition of the cationic lipid dimethyl dioctadecylammonium bromide (DDA) and the immunostimulatory trehalose 6,6'-dibehenate (TDB), either separately or in combination, was investigated for the effect on particle size and distribution, antigen entrapment efficiency, in vitro release profiles and in vivo performance. Optimised formulation parameters yielded microspheres within the desired sub-10 mu m range (1.50 +/- 0.13 mu m), whilst exhibiting a high antigen entrapment efficiency (95 +/- 1.2%) and prolonged release profiles. Although the microsphere formulations induced a cell-mediated immune response and raised specific antibodies after immunisation, this was inferior to the levels achieved with liposomes composed of the same adjuvants (DDA-TDB), demonstrating that liposomes are more effective vaccine delivery systems compared with microspheres.

W Primary Care Trust v TB & Ors [2009] EWHC 1737

The primary issue in this case related to TB’s clear and expressed desire to leave V, in order that she might be admitted to an NHS hospital for treatment of what she believed to be a physical, as opposed to a psychological, condition...

73.7 Tb/s (96 x 3 x 256-Gb/s) mode-division-multiplexed DP-16QAM transmission with inline MM-EDFA

Transmission of a 73.7 Tb/s (96x3x256-Gb/s) DP-16QAM mode-division-multiplexed signal over 119km of few-mode fiber transmission line incorporating an inline multi mode EDFA and a phase plate based mode (de-)multiplexer is demonstrated. Data-aided 6x6 MIMO digital signal processing was used to demodulate the signal. The total demonstrated net capacity, taking into account 20% of FEC-overhead and 7.5% additional overhead (Ethernet and training sequences), is 57.6 Tb/s, corresponding to a spectral efficiency of 12 bits/s/Hz.

Impact of Raman amplification on a 2 Tb/s coherent WDM system

The impact of hybrid erbium-doped fiber amplifier (EDFA)/Raman amplification on a spectrally efficient coherent-wavelength-division-multiplexed (CoWDM) optical communication system is experimentally studied and modeled. Simulations suggested that 23-dB Raman gain over an unrepeatered span of 124 km single-mode fiber would allow a decrease of the mean input power of ~6 dB for a fixed bit-error rate (BER). Experimentally we demonstrated 1.2-dB Q-factor improvement for a 2-Tb/s seven-band CoWDM with backward Raman amplification. The system delivered an optical signal-to-noise ratio of 35 dB at the output of the receiver preamplifier providing a worst-case BER of 2 × 10 -6 over 49 subcarriers at 42.8 Gbaud, leaving a system margin (in terms of Q -factor) of ~4 dB from the forward-error correction threshold.

1-Tb/s DWDM long-haul transmission employing a fiber optical parametric amplifier

In this letter, we report the performance of a fiber optical parametric amplifier (OPA) when used as a source or intermediate node amplifier in a dense wavelength-division-multiplexed (DWDM) long-haul transmission testbed with 26 DWDM channels modulated at 43.7-Gb/s return-to-zero differential phase-shift keying. In both scenarios, we demonstrate similar performance to an erbium-doped fiber amplifier. This shows the OPAs compatibility with high-capacity (>1 Tb/s) long-haul communication systems.

Fiber optical parametric amplifier performance in a 1-Tb/s DWDM communication system

We have reduced signal-signal four-wave mixing crosstalk in a fiber optical parametric amplifier (OPA) by using a short nonlinear fiber for the gain medium and a high-power pump. This allowed us to obtain less than 1 dB penalty for amplification of 26 dense wavelength-division multiplexed (WDM) channels modulated at 43.7Gb/s return to zero-differential phase-shift keying, with the OPA placed between transmitter and receiver. We then used the same OPA in several different roles for a long-haul transmission system. We did not insert the OPA within the loop, but investigated this role indirectly by using equivalent results for small numbers of loop recirculations. We found that standard erbium-doped fiber amplifiers currently hold an advantage over this OPA, which becomes negligible for long distances. This paper shows that at this time OPAs can handle amplification of WDM traffic in excess of 1 Tb/s with little degradation. It also indicates that with further improvements, fiber OPAs could be a contender for wideband amplification in future optical communication networks.

1-Tb/s DWDM amplification in a fiber optical parametric amplifier

We report less than 1-dB cross-talk penalty for 26 DWDM channels modulated at 43.7 Gb/s RZ-DPSK when amplified by a fiber optical parametric amplifier showing compatibility with high-capacity (> 1 Tb/s) communication systems. © 2010 Optical Society of America.

1-Tb/s DWDM amplification in a fiber optical parametric amplifier

We report less than 1-dB cross-talk penalty for 26 DWDM channels modulated at 43.7 Gb/s RZ-DPSK when amplified by a fiber optical parametric amplifier showing compatibility with high-capacity (> 1 Tb/s) communication systems. © 2010 Optical Society of America.

1-Tb/s DWDM long-haul transmission employing a fiber optical parametric amplifier

In this letter, we report the performance of a fiber optical parametric amplifier (OPA) when used as a source or intermediate node amplifier in a dense wavelength-division-multiplexed (DWDM) long-haul transmission testbed with 26 DWDM channels modulated at 43.7-Gb/s return-to-zero differential phase-shift keying. In both scenarios, we demonstrate similar performance to an erbium-doped fiber amplifier. This shows the OPAs compatibility with high-capacity (>1 Tb/s) long-haul communication systems.

Digital fiber nonlinearity compensation:toward 1-Tb/s transport

The world is connected by a core network of long-haul optical communication systems that link countries and continents, enabling long-distance phone calls, data-center communications, and the Internet. The demands on information rates have been constantly driven up by applications such as online gaming, high-definition video, and cloud computing. All over the world, end-user connection speeds are being increased by replacing conventional digital subscriber line (DSL) and asymmetric DSL (ADSL) with fiber to the home. Clearly, the capacity of the core network must also increase proportionally. © 1991-2012 IEEE.

73.7 Tb/s (96X3x256-Gb/s) mode-division-multiplexed DP-16QAM transmission with inline MM-EDFA

We show transmission of a 73.7 Tb/s (96x3x256-Gb/s) DP-16QAM modedivision- multiplexed signal over 119km of few-mode fiber with inline multi-mode EDFA, using 6x6 MIMO digital signal processing. The total demonstrated net capacity is 57.6 Tb/s (SE 12 bits/s/Hz). © 2012 OSA.