Valutazione dell’impiego dei test per la genotipizzazione di HPV e l’espressione degli oncogeni virali nel follow-up di donne conizzate per lesioni cervicali di alto grado nello screening del cervico-carcinoma della Regione Emilia-Romagna

Obiettivi: Valutare la prevalenza dei diversi genotipi di HPV in pazienti con diagnosi di CIN2/3 nella Regione Emilia-Romagna, la persistenza genotipo-specifica di HPV e l’espressione degli oncogeni virali E6/E7 nel follow-up post-trattamento come fattori di rischio di recidiva/persistenza o progressione di malattia; verificare l’applicabilità di nuovi test diagnostici biomolecolari nello screening del cervicocarcinoma. Metodi: Sono state incluse pazienti con citologia di screening anormale, sottoposte a trattamento escissionale (T0) per diagnosi di CIN2/3 su biopsia mirata. Al T0 e durante il follow-up a 6, 12, 18 e 24 mesi, oltre al Pap test e alla colposcopia, sono state effettuate la ricerca e la genotipizzazione dell'HPV DNA di 28 genotipi. In caso di positività al DNA dei 5 genotipi 16, 18, 31, 33 e/o 45, si è proceduto alla ricerca dell'HPV mRNA di E6/E7. Risultati preliminari: Il 95.8% delle 168 pazienti selezionate è risultato HPV DNA positivo al T0. Nel 60.9% dei casi le infezioni erano singole (prevalentemente da HPV 16 e 31), nel 39.1% erano multiple. L'HPV 16 è stato il genotipo maggiormente rilevato (57%). Il 94.3% (117/124) delle pazienti positive per i 5 genotipi di HPV DNA sono risultate mRNA positive. Abbiamo avuto un drop-out di 38/168 pazienti. A 18 mesi (95% delle pazienti) la persistenza dell'HPV DNA di qualsiasi genotipo era del 46%, quella dell'HPV DNA dei 5 genotipi era del 39%, con espressione di mRNA nel 21%. Abbiamo avuto recidiva di malattia (CIN2+) nel 10.8% (14/130) a 18 mesi. Il pap test era negativo in 4/14 casi, l'HPV DNA test era positivo in tutti i casi, l'mRNA test in 11/12 casi. Conclusioni: L'HR-HPV DNA test è più sensibile della citologia, l'mRNA test è più specifico nell'individuare una recidiva. I dati definitivi saranno disponibili al termine del follow-up programmato.

Test of Lorentz symmetry with a 3 He,129 Xe clock-comparison experiment

In case of violation of CPT- and Lorentz Symmetry, the minimal Standard Model Extension (SME) of Kostelecky and coworkers predicts sidereal modulations of atomic transition frequencies as the Earth rotates relative to a Lorentz-violating background field. One method to search for these modulations is the so-called clock-comparison experiment, where the frequencies of co-located clocks are compared as they rotate with respect to the fixed stars. In this work an experiment is presented where polarized 3He and 129Xe gas samples in a glass cell serve as clocks, whose nuclear spin precession frequencies are detected with the help of highly sensitive SQUID sensors inside a magnetically shielded room. The unique feature of this experiment is the fact that the spins are precessing freely, with transverse relaxation times of up to 4.4 h for 129Xe and 14.1 h for 3He. To be sensitive to Lorentz-violating effects, the influence of external magnetic fields is canceled via the weighted difference of the 3He and 129Xe frequencies or phases. The Lorentz-violating SME parameters for the neutron are determined out of a fit on the phase difference data of 7 spin precession measurements of 12 to 16 hours length. The result of the fit gives an upper limit for the equatorial component of the neutron parameter b_n of 3.7×10^(−32) GeV at the 95% confidence level. This value is not limited by the signal-to-noise ratio, but by the strong correlations between the fit parameters. To reduce the correlations and therewith improve the sensitivity of future experiments, it will be necessary to change the time structure of the weighted phase difference, which can be realized by increasing the 129Xe relaxation time.

Production of Z bosons in proton-proton collisions at root out s = 10 TeV: Expectations for early measurements at the ATLAS experiment

The production of the Z boson in proton-proton collisions at the LHC serves as a standard candle at the ATLAS experiment during early data-taking. The decay of the Z into an electron-positron pair gives a clean signature in the detector that allows for calibration and performance studies. The cross-section of ~ 1 nb allows first LHC measurements of parton density functions. In this thesis, simulations of 10 TeV collisions at the ATLAS detector are studied. The challenges for an experimental measurement of the cross-section with an integrated luminositiy of 100 pb−1 are discussed. In preparation for the cross-section determination, the single-electron efficiencies are determined via a simulation based method and in a test of a data-driven ansatz. The two methods show a very good agreement and differ by ~ 3% at most. The ingredients of an inclusive and a differential Z production cross-section measurement at ATLAS are discussed and their possible contributions to systematic uncertainties are presented. For a combined sample of signal and background the expected uncertainty on the inclusive cross-section for an integrated luminosity of 100 pb−1 is determined to 1.5% (stat) +/- 4.2% (syst) +/- 10% (lumi). The possibilities for single-differential cross-section measurements in rapidity and transverse momentum of the Z boson, which are important quantities because of the impact on parton density functions and the capability to check for non-pertubative effects in pQCD, are outlined. The issues of an efficiency correction based on electron efficiencies as function of the electron’s transverse momentum and pseudorapidity are studied. A possible alternative is demonstrated by expanding the two-dimensional efficiencies with the additional dimension of the invariant mass of the two leptons of the Z decay.

Valutazione della mobilita' di contaminanti inorganici tramite test di cessione su matrici ambientali contaminate

La caratterizzazione di sedimenti contaminati è un problema complesso, in questo lavoro ci si è occupati di individuare una metodologia di caratterizzazione che tenesse conto sia delle caratteristiche della contaminazione, con analisi volte a determinare il contenuto totale di contaminanti, sia della mobilità degli inquinanti stessi. Una adeguata strategia di caratterizzazione può essere applicata per la valutazione di trattamenti di bonifica, a questo scopo si è valutato il trattamento di soil washing, andando ad indagare le caratteristiche dei sedimenti dragati e del materiale in uscita dal processo, sabbie e frazione fine, andando inoltre a confrontare le caratteristiche della sabbia in uscita con quelle delle sabbie comunemente usate per diverse applicazioni. Si è ritenuto necessario indagare la compatibilità dal punto di vista chimico, granulometrico e morfologico. Per indagare la mobilità si è scelto di applicare i test di cessione definiti sia a livello internazionale che italiano (UNI) e quindi si sono sviluppate le tecnologie necessarie alla effettuazione di test di cessione in modo efficace, automatizzando la gestione del test a pHstat UNI CEN 14997. Questo si è reso necessario a causa della difficoltà di gestire il test manualmente, per via delle tempistiche difficilmente attuabili da parte di un operatore. Le condizioni redox influenzano la mobilità degli inquinanti, in particolare l’invecchiamento all’aria di sedimenti anossici provoca variazioni sensibili nello stato d’ossidazione di alcune componenti, incrementandone la mobilità, si tratta quindi di un aspetto da considerare quando si individuano le adeguate condizioni di stoccaggio-smaltimento, si è eseguita a questo scopo una campagna sperimentale.

The Permanent Income Hypothesis: A Test on Czech Privatisation

Since the late eighties, economists have been regarding the transition from command to market economies in Central and Eastern Europe with intense interest. In addition to studying the transition per se, they have begun using the region as a testing ground on which to investigate the validity of certain classic economic propositions. In his research, comprising three articles written in English and totalling 40 pages, Mr. Hanousek uses the so-called "Czech national experiment" (voucher privatisation scheme) to test the permanent income hypothesis (PIH). He took as his inspiration Kreinin's recommendation: "Since data concerning the behaviour of windfall income recipients is relatively scanty, and since such data can constitute an important test of the permanent income hypothesis, it is of interest to bring to bear on the hypothesis whatever information is available". Mr. Hanousek argues that, since the transfer of property to Czech citizens from 1992 to 1994 through the voucher scheme was not anticipated, it can be regarded as windfall income. The average size of the windfall was more than three month's salary and over 60 percent of the Czech population received this unexpected income. Furthermore, there are other reasons for conducting such an analysis in the Czech Republic. Firstly, the privatisation process took place quickly. Secondly, both the economy and consumer behaviour have been very stable. Thirdly, out of a total population of 10 million Czech citizens, an astonishing 6 million, that is, virtually every household, participated in the scheme. Thus Czech voucher privatisation provides a sample for testing the PIH almost equivalent to a full population, thus avoiding problems with the distribution of windfalls. Compare this, for instance with the fact that only 4% of the Israeli urban population received personal restitution from Germany, while the number of veterans who received the National Service Life Insurance Dividends amounted to less than 9% of the US population and were concentrated in certain age groups. But to begin with, Mr. Hanousek considers the question of whether the public percieves the transfer from the state to individual as an increase in net wealth. It can be argued that the state is only divesting itself of assets that would otherwise provide a future source of transfers. According to this argument, assigning these assets to individuals creates an offsetting change in the present value of potential future transfers so that individuals are no better off after the transfer. Mr. Hanousek disagrees with this approach. He points out that a change in the ownership of inefficient state-owned enterprises should lead to higher efficiency, which alone increases the value of enterprises and creates a windfall increase in citizens' portfolios. More importantly, the state and individuals had very different preferences during the transition. Despite government propaganda, it is doubtful that citizens of former communist countries viewed government-owned enterprises as being operated in the citizens' best interest. Moreover, it is unlikely that the public fully comprehended the sophisticated links between the state budget, state-owned enterprises, and transfers to individuals. Finally, the transfers were not equal across the population. Mr. Hanousek conducted a survey on 1263 individuals, dividing them into four monthly earnings categories. After determining whether the respondent had participated in the voucher process, he asked those who had how much of what they received from voucher privatisation had been (a) spent on goods and services, (b) invested elsewhere, (c) transferred to newly emerging pension funds, (d) given to a family member, and (e) retained in their original form as an investment. Both the mean and the variance of the windfall rise with income. He obtained similar results with respect to education, where the mean (median) windfall for those with a basic school education was 13,600 Czech Crowns (CZK), a figure that increased to 15,000 CZK for those with a high school education without exams, 19,900 CZK for high school graduates with exams, and 24,600 CZK for university graduates. Mr. Hanousek concludes that it can be argued that higher income (and better educated) groups allocated their vouchers or timed the disposition of their shares better. He turns next to an analysis of how respondents reported using their windfalls. The key result is that only a relatively small number of individuals reported spending on goods. Overall, the results provide strong support for the permanent income hypothesis, the only apparent deviation being the fact that both men and women aged 26 to 35 apparently consume more than they should if the windfall were annuitised. This finding is still fully consistent with the PIH, however, if this group is at a stage in their life-cycle where, without the windfall, they would be borrowing to finance consumption associated with family formation etc. Indeed, the PIH predicts that individuals who would otherwise borrow to finance consumption would consume the windfall up to the level equal to the annuitised fraction of the increase in lifetime income plus the full amount of the previously planned borrowing for consumption. Greater consumption would then be financed, not from investing the windfall, but from avoidance of future repayment obligations for debts that would have been incurred without the windfall.

Accuracy of B-type natriuretic peptide tests to exclude congestive heart failure: systematic review of test accuracy studies

BACKGROUND: Congestive heart failure (CHF) is a major public health problem. The use of B-type natriuretic peptide (BNP) tests shows promising diagnostic accuracy. Herein, we summarize the evidence on the accuracy of BNP tests in the diagnosis of CHF and compare the performance of rapid enzyme-linked immunosorbent assay (ELISA) and standard radioimmunosorbent assay (RIA) tests. METHODS: We searched electronic databases and the reference lists of included studies, and we contacted experts. Data were extracted on the study population, the type of test used, and methods. Receiver operating characteristic (ROC) plots and summary ROC curves were produced and negative likelihood ratios pooled. Random-effect meta-analysis and metaregression were used to combine data and explore sources of between-study heterogeneity. RESULTS: Nineteen studies describing 22 patient populations (9 ELISA and 13 RIA) and 9093 patients were included. The diagnosis of CHF was verified by echocardiography, radionuclide scan, or echocardiography combined with clinical criteria. The pooled negative likelihood ratio overall from random-effect meta-analysis was 0.18 (95% confidence interval [CI], 0.13-0.23). It was lower for the ELISA test (0.12; 95% CI, 0.09-0.16) than for the RIA test (0.23; 95% CI, 0.16-0.32). For a pretest probability of 20%, which is typical for patients with suspected CHF in primary care, a negative result of the ELISA test would produce a posttest probability of 2.9%; a negative RIA test, a posttest probability of 5.4%. CONCLUSIONS: The use of BNP tests to rule out CHF in primary care settings could reduce demand for echocardiography. The advantages of rapid ELISA tests need to be balanced against their higher cost.

Multicentre evaluation of a new point-of-care test for the determination of NT-proBNP in whole blood

BACKGROUND: The Roche CARDIAC proBNP point-of-care (POC) test is the first test intended for the quantitative determination of N-terminal pro-brain natriuretic peptide (NT-proBNP) in whole blood as an aid in the diagnosis of suspected congestive heart failure, in the monitoring of patients with compensated left-ventricular dysfunction and in the risk stratification of patients with acute coronary syndromes. METHODS: A multicentre evaluation was carried out to assess the analytical performance of the POC NT-proBNP test at seven different sites. RESULTS: The majority of all coefficients of variation (CVs) obtained for within-series imprecision using native blood samples was below 10% for both 52 samples measured ten times and for 674 samples measured in duplicate. Using quality control material, the majority of CV values for day-to-day imprecision were below 14% for the low control level and below 13% for the high control level. In method comparisons for four lots of the POC NT-proBNP test with the laboratory reference method (Elecsys proBNP), the slope ranged from 0.93 to 1.10 and the intercept ranged from 1.8 to 6.9. The bias found between venous and arterial blood with the POC NT-proBNP method was < or =5%. All four lots of the POC NT-proBNP test investigated showed excellent agreement, with mean differences of between -5% and +4%. No significant interference was observed with lipaemic blood (triglyceride concentrations up to 6.3 mmol/L), icteric blood (bilirubin concentrations up to 582 micromol/L), haemolytic blood (haemoglobin concentrations up to 62 mg/L), biotin (up to 10 mg/L), rheumatoid factor (up to 42 IU/mL), or with 50 out of 52 standard or cardiological drugs in therapeutic concentrations. With bisoprolol and BNP, somewhat higher bias in the low NT-proBNP concentration range (<175 ng/L) was found. Haematocrit values between 28% and 58% had no influence on the test result. Interference may be caused by human anti-mouse antibodies (HAMA) types 1 and 2. No significant influence on the results with POC NT-proBNP was found using volumes of 140-165 muL. High NT-proBNP concentrations above the measuring range of the POC NT-proBNP test did not lead to false low results due to a potential high-dose hook effect. CONCLUSIONS: The POC NT-proBNP test showed good analytical performance and excellent agreement with the laboratory method. The POC NT-proBNP assay is therefore suitable in the POC setting.

Manual pumping test method for characterizing the productivity of drilled wells equipped with rope pumps

Since the introduction of the rope-pump in Nicaragua in the 1990s, the dependence on wells in rural areas has grown steadily. However, little or no attention is paid to rope-pump well performance after installation. Due to financial restraints, groundwater resource monitoring using conventional testing methods is too costly and out of reach of rural municipalities. Nonetheless, there is widespread agreement that without a way to quantify the changes in well performance over time, prioritizing regulatory actions is impossible. A manual pumping test method is presented, which at a fraction of the cost of a conventional pumping test, measures the specific capacity of rope-pump wells. The method requires only sight modifcations to the well and reasonable limitations on well useage prior to testing. The pumping test was performed a minimum of 33 times in three wells over an eight-month period in a small rural community in Chontales, Nicaragua. Data was used to measure seasonal variations in specific well capacity for three rope-pump wells completed in fractured crystalline basalt. Data collected from the tests were analyzed using four methods (equilibrium approximation, time-drawdown during pumping, time-drawdown during recovery, and time-drawdown during late-time recovery) to determine the best data-analyzing method. One conventional pumping test was performed to aid in evaluating the manual method. The equilibrim approximation can be performed while in the field with only a calculator and is the most technologically appropriate method for analyzing data. Results from this method overestimate specific capacity by 41% when compared to results from the conventional pumping test. The other analyes methods, requiring more sophisticated tools and higher-level interpretation skills, yielded results that agree to within 14% (pumping phase), 31% (recovery phase) and 133% (late-time recovery) of the conventional test productivity value. The wide variability in accuracy results principally from difficulties in achieving equilibrated pumping level and casing storage effects in the puping/recovery data. Decreases in well productivity resulting from naturally occuring seasonal water-table drops varied from insignificant in two wells to 80% in the third. Despite practical and theoretical limitations on the method, the collected data may be useful for municipal institutions to track changes in well behavior, eventually developing a database for planning future ground water development projects. Furthermore, the data could improve well-users’ abilities to self regulate well usage without expensive aquifer characterization.

Attempting to improve standardized test results using Study Islands' web-based mastery program

State standardized testing has always been a tool to measure a school’s performance and to help evaluate school curriculum. However, with the school of choice legislation in 1992, the MEAP test became a measuring stick to grade schools by and a major tool in attracting school of choice students. Now, declining enrollment and a state budget struggling to stay out of the red have made school of choice students more important than ever before. MEAP scores have become the deciding factor in some cases. For the past five years, the Hancock Middle School staff has been working hard to improve their students’ MEAP scores in accordance with President Bush's “No Child Left Behind” legislation. In 2005, the school was awarded a grant that enabled staff to work for two years on writing and working towards school goals that were based on the improvement of MEAP scores in writing and math. As part of this effort, the school purchased an internet-based program geared at giving students practice on state content standards. This study examined the results of efforts by Hancock Middle School to help improve student scores in mathematics on the MEAP test through the use of an online program called “Study Island.” In the past, the program was used to remediate students, and as a review with an incentive at the end of the year for students completing a certain number of objectives. It had also been used as a review before upcoming MEAP testing in the fall. All of these methods may have helped a few students perform at an increased level on their standardized test, but the question remained of whether a sustained use of the program in a classroom setting would increase an understanding of concepts and performance on the MEAP for the masses. This study addressed this question. Student MEAP scores and Study Island data from experimental and comparison groups of students were compared to understand how a sustained use of Study Island in the classroom would impact student test scores on the MEAP. In addition, these data were analyzed to determine whether Study Island results provide a good indicator of students’ MEAP performance. The results of the study suggest that there were limited benefits related to sustained use of Study Island and gave some indications about the effectiveness of the mathematics curriculum at Hancock Middle School. These results and implications for instruction are discussed.

Cut Out By The Middle Man: The Free Speech Implications Of Social Network Blocking and Banning In The EU

This article examines social network users’ legal defences against content removal under the EU and ECHR frameworks, and their implications for the effective exercise of free speech online. A review of the Terms of Use and content moderation policies of two major social network services, Facebook and Twitter, shows that end users are unlikely to have a contractual defence against content removal. Under the EU and ECHR frameworks, they may demand the observance of free speech principles in state-issued blocking orders and their implementation by intermediaries, but cannot invoke this ‘fair balance’ test against the voluntary removal decisions by the social network service. Drawing on practical examples, this article explores the threat to free speech created by this lack of accountability: Firstly, a shift from legislative regulation and formal injunctions to public-private collaborations allows state authorities to influence these ostensibly voluntary policies, thereby circumventing constitutional safeguards. Secondly, even absent state interference, the commercial incentives of social media cannot be guaranteed to coincide with democratic ideals. In light of the blurring of public and private functions in the regulation of social media expression, this article calls for the increased accountability of the social media services towards end users regarding the observance of free speech principles

Solute transport in crystalline rocks at Äspö — II: Blind predictions, inverse modelling and lessons learnt from test STT1

Based on the results from detailed structural and petrological characterisation and on up-scaled laboratory values for sorption and diffusion, blind predictions were made for the STT1 dipole tracer test performed in the Swedish A¨ spo¨ Hard Rock Laboratory. The tracers used were nonsorbing, such as uranine and tritiated water, weakly sorbing 22Na+, 85Sr2 +, 47Ca2 +and more strongly sorbing 86Rb+, 133Ba2 +, 137Cs+. Our model consists of two parts: (1) a flow part based on a 2D-streamtube formalism accounting for the natural background flow field and with an underlying homogeneous and isotropic transmissivity field and (2) a transport part in terms of the dual porosity medium approach which is linked to the flow part by the flow porosity. The calibration of the model was done using the data from one single uranine breakthrough (PDT3). The study clearly showed that matrix diffusion into a highly porous material, fault gouge, had to be included in our model evidenced by the characteristic shape of the breakthrough curve and in line with geological observations. After the disclosure of the measurements, it turned out that, in spite of the simplicity of our model, the prediction for the nonsorbing and weakly sorbing tracers was fairly good. The blind prediction for the more strongly sorbing tracers was in general less accurate. The reason for the good predictions is deemed to be the result of the choice of a model structure strongly based on geological observation. The breakthrough curves were inversely modelled to determine in situ values for the transport parameters and to draw consequences on the model structure applied. For good fits, only one additional fracture family in contact with cataclasite had to be taken into account, but no new transport mechanisms had to be invoked. The in situ values for the effective diffusion coefficient for fault gouge are a factor of 2–15 larger than the laboratory data. For cataclasite, both data sets have values comparable to laboratory data. The extracted Kd values for the weakly sorbing tracers are larger than Swedish laboratory data by a factor of 25–60, but agree within a factor of 3–5 for the more strongly sorbing nuclides. The reason for the inconsistency concerning Kds is the use of fresh granite in the laboratory studies, whereas tracers in the field experiments interact only with fracture fault gouge and to a lesser extent with cataclasite both being mineralogically very different (e.g. clay-bearing) from the intact wall rock.

Can a novel computerized cognitive screening test provide additional information for early detection of Alzheimer's disease?

BACKGROUND: Virtual reality testing of everyday activities is a novel type of computerized assessment that measures cognitive, executive, and motor performance as a screening tool for early dementia. This study used a virtual reality day-out task (VR-DOT) environment to evaluate its predictive value in patients with mild cognitive impairment (MCI). METHODS: One hundred thirty-four patients with MCI were selected and compared with 75 healthy control subjects. Participants received an initial assessment that included VR-DOT, a neuropsychological evaluation, magnetic resonance imaging (MRI) scan, and event-related potentials (ERPs). After 12 months, participants were assessed again with MRI, ERP, VR-DOT, and neuropsychological tests. RESULTS: At the end of the study, we differentiated two subgroups of patients with MCI according to their clinical evolution from baseline to follow-up: 56 MCI progressors and 78 MCI nonprogressors. VR-DOT performance profiles correlated strongly with existing predictive biomarkers, especially the ERP and MRI biomarkers of cortical thickness. CONCLUSIONS: Compared with ERP, MRI, or neuropsychological tests alone, the VR-DOT could provide additional predictive information in a low-cost, computerized, and noninvasive way.

Clinical usefulness of gene-expression profile to rule out acute rejection after heart transplantation: CARGO II.

AIMS A non-invasive gene-expression profiling (GEP) test for rejection surveillance of heart transplant recipients originated in the USA. A European-based study, Cardiac Allograft Rejection Gene Expression Observational II Study (CARGO II), was conducted to further clinically validate the GEP test performance. METHODS AND RESULTS Blood samples for GEP testing (AlloMap(®), CareDx, Brisbane, CA, USA) were collected during post-transplant surveillance. The reference standard for rejection status was based on histopathology grading of tissue from endomyocardial biopsy. The area under the receiver operating characteristic curve (AUC-ROC), negative (NPVs), and positive predictive values (PPVs) for the GEP scores (range 0-39) were computed. Considering the GEP score of 34 as a cut-off (>6 months post-transplantation), 95.5% (381/399) of GEP tests were true negatives, 4.5% (18/399) were false negatives, 10.2% (6/59) were true positives, and 89.8% (53/59) were false positives. Based on 938 paired biopsies, the GEP test score AUC-ROC for distinguishing ≥3A rejection was 0.70 and 0.69 for ≥2-6 and >6 months post-transplantation, respectively. Depending on the chosen threshold score, the NPV and PPV range from 98.1 to 100% and 2.0 to 4.7%, respectively. CONCLUSION For ≥2-6 and >6 months post-transplantation, CARGO II GEP score performance (AUC-ROC = 0.70 and 0.69) is similar to the CARGO study results (AUC-ROC = 0.71 and 0.67). The low prevalence of ACR contributes to the high NPV and limited PPV of GEP testing. The choice of threshold score for practical use of GEP testing should consider overall clinical assessment of the patient's baseline risk for rejection.

Evaluation of the T-SPOT(RTM).TB test in the diagnosis of latent tuberculosis infection in HIV-infected children in Uganda

Background. About a third of the world’s population is infected with tuberculosis (TB) with sub-Saharan Africa being the worst hit. Uganda is ranked 16th among the countries with the biggest TB burden. The burden in children however has not been determined. The burden of TB has been worsened by the advent of HIV and TB is the leading cause of mortality in HIV infected individuals. Development of TB disease can be prevented if TB is diagnosed during its latent stage and treated with isoniazid. For over a century, latent TB infection (LTBI) was diagnosed using the Tuberculin Skin Test (TST). New interferon gamma release assays (IGRA) have been approved by FDA for the diagnosis of LTBI and adult studies have shown that IGRAs are superior to the TST but there have been few studies in children especially in areas of high TB and HIV endemicity. ^ Objective. The objective of this study was to examine whether the IGRAs had a role in LTBI diagnosis in HIV infected children in Uganda. ^ Methods. Three hundred and eighty one (381) children were recruited at the Baylor College of Medicine-Bristol Meyers Squibb Children’s Clinical Center of Excellence at Mulago Hospital, Kampala, Uganda between March and August 2010. All the children were subjected to a TST and T-SPOT ®.TB test which was the IGRA chosen for this study. Sputum examination and chest x-rays were also done to rule out active TB. ^ Results. There was no statistically significant difference between the tests. The agreement between the two assays was 95.9% and the kappa statistic was 0.7 (95% CI: 0.55–0.85, p-value<0.05) indicating a substantial or good agreement. The TST was associated with older age and higher weight for age z-scores but the T-SPOT®. TB was not. Both tests were associated with history of taking anti-retroviral therapy (ART). ^ Conclusion. Before promoting use of IGRAs in children living in HIV/TB endemic countries, more research needs to be done. ^

Development of a standard sign-out procedure for clinicians in a pediatric intensive care unit

Background: Poor communication among health care providers is cited as the most common cause of sentinel events involving patients. Sign-out of patient data at the change of clinician shifts is a component of communication that is especially vulnerable to errors. Sign-outs are particularly extensive and complex in intensive care units (ICUs). There is a paucity of validated tools to assess ICU sign-outs. ^ Objective: To design a valid and reliable survey tool to assess the perceptions of Pediatric ICU (PICU) clinicians about sign-out. ^ Design: Cross-sectional, web-based survey ^ Setting: Academic hospital, 31-bed PICU ^ Subjects: Attending faculty, fellows, nurse practitioners and physician assistants. ^ Interventions: A survey was designed with input from a focus group and administered to PICU clinicians. Test-retest reliability, internal consistency and validity of the survey tool were assessed. ^ Measurements and Main Results: Forty-eight PICU clinicians agreed to participate. We had 42(88%) and 40(83%) responses in the test and retest phases. The mean scores for the ten survey items ranged from 2.79 to 3.67 on a five point Likert scale with no significant test-retest difference and a Pearson correlation between pre and post answers of 0.65. The survey item scores showed internal consistency with a Cronbach's Alpha of 0.85. Exploratory factor analysis revealed three constructs: efficacy of sign-out process, recipient satisfaction and content applicability. Seventy eight % clinicians affirmed the need for improvement of the sign-out process and 83% confirmed the need for face- to-face verbal sign-out. A system-based sign-out format was favored by fellows and advanced level practitioners while attendings preferred a problem-based format (p=0.003). ^ Conclusions: We developed a valid and reliable survey to assess clinician perceptions about the ICU sign-out process. These results can be used to design a verbal template to improve and standardize the sign-out process.^