•The recently published Dutch protocol advises to make use of additional diagnostics in case of MCS<6mm.•Most Dutch surgeons are not aware of this protocol and do not make use of it.•Most Dutch ...surgeons treat type B fibula fractures surgically, even with no proven medial injury. This will lead to unnecessary surgery.•There is no consensus in treatment nor diagnostics of type B fibula fractures in the Netherlands. The current protocol is not being followed.
In isolated Weber B fractures (type B fibular fractures), ruling out instability is critical for safe conservative treatment. In fractures without evident medial injury, additional diagnostics like MRI scan or gravity stress test should be done to differentiate between a stable and unstable fracture. The aim of the current study is to gain more insight in current practice and treatment of type B fractures by Dutch trauma- and orthopaedic surgeons.
In December 2017 and January 2018, 559 trauma surgeons were invited by email to join an online survey. This survey consisted of questions regarding diagnostics and treatment of isolated distal fibula fractures. Also, respondents were asked to state their preferred treatment of eight separate cases.
In total, 161 surgeons participated, covering 68 different hospitals in the Netherlands. Of them, 32.0% treat more than 30 ankle fractures a year. Based on regular mortise radiographs, 13.6% of the respondents chose surgical treatment in case of a medial clear space (MCS) > 4 mm, 33.8% in case of a MCS > 6 mm and 45.5% in case of a MCS > 4 mm in addition to the MCS ≥ superior clear space + 1 mm. Moreover, 18.2% make use of additional diagnostics (43.9% repeat mortise view after a week, 16.6% weight bearing radiograph, 8.6% gravity stress view, 7.9% exorotation radiograph, 6.5% MRI scan, 0.7% ultrasound, 16.8% other) and 8% establishes their decision not based on the mortise radiograph. Fibular dislocation of ≥ 2 mm was used as an indication for surgical treatment by 69%. Of them, 56% decides to treat surgically in these cases, even with proven medial stability.
Many surgeons treat type B fibular fractures with a MCS > 4 mm at mortise view surgically, even without proven medial injury. Rarely, additional diagnostics as MRI or gravity stress test are performed in cases with a MCS 4–6 mm. Consequently many stable ankle fractures are treated operatively unnecessarily.
ITER beam aided diagnostics Levinton, F.M.; Reichert, H.; De Bock, M.
Journal of instrumentation,
02/2022, Letnik:
17, Številka:
2
Journal Article
Recenzirano
Abstract
We provide an overview of ITER beam aided diagnostics, including the motional Stark effect (MSE) and charge exchange recombination spectroscopy (CXRS). ITER presents several unique ...challenges to plasma diagnostics in general and beam-aided diagnostics in particular. The large size, long pulse, and DT operation drives much of the diagnostic design. This in turn has driven a significant R&D effort concerning the maintenance of plasma facing mirrors with sufficient reflectivity to maintain the utility of the diagnostic. In the case of MSE a new approach utilizing spectral splitting will be pursued instead of the conventional polarimetry approach due to the difficulty of maintaining and calibrating the polarizations properties of the plasma facing mirror.
Abstract
Unfolding techniques are employed to reconstruct the 1D energy distribution of runaway electrons from Bremsstrahlung hard X-ray spectrum emitted during plasma disruptions in tokamaks. Here ...we compare four inversion methods: truncated singular value decomposition, which is a linear algebra technique, maximum likelihood expectation maximization, which is an iterative method, and Tikhonov regularization applied to
χ
2
and Poisson statistics, which are two minimization approaches. The reconstruction fidelity and the capability of estimating cumulative statistics, such as the mean and maximum energy, have been assessed on both synthetic and experimental spectra. The effect of measurements limitations, such as the low energy cut and few number of counts, on the final reconstruction has also been studied. We find that the iterative method performs best as it better describes the statistics of the experimental data and is more robust to noise in the recorded spectrum.
Background
In 2010, the World Health Organization recommended that all patients with suspected malaria are tested for malaria before treatment. In rural African settings light microscopy is often ...unavailable. Diagnosis has relied on detecting fever, and most people were given antimalarial drugs presumptively. Rapid diagnostic tests (RDTs) provide a point‐of‐care test that may improve management, particularly of people for whom the RDT excludes the diagnosis of malaria.
Objectives
To evaluate whether introducing RDTs into algorithms for diagnosing and treating people with fever improves health outcomes, reduces antimalarial prescribing, and is safe, compared to algorithms using clinical diagnosis.
Search methods
We searched the Cochrane Infectious Disease Group Specialized Register; CENTRAL (The Cochrane Library); MEDLINE; EMBASE; CINAHL; LILACS; and the metaRegister of Controlled Trials for eligible trials up to 10 January 2014. We contacted researchers in the field and reviewed the reference lists of all included trials to identify any additional trials.
Selection criteria
Individual or cluster randomized trials (RCTs) comparing RDT‐supported algorithms and algorithms using clinical diagnosis alone for diagnosing and treating people with fever living in malaria‐endemic settings.
Data collection and analysis
Two authors independently applied the inclusion criteria and extracted data. We combined data from individually and cluster RCTs using the generic inverse variance method. We presented all outcomes as risk ratios (RR) with 95% confidence intervals (CIs), and assessed the quality of evidence using the GRADE approach.
Main results
We included seven trials, enrolling 17,505 people with fever or reported history of fever in this review; two individually randomized trials and five cluster randomized trials. All trials were conducted in rural African settings.
In most trials the health workers diagnosing and treating malaria were nurses or clinical officers with less than one week of training in RDT supported diagnosis. Health worker prescribing adherence to RDT results was highly variable: the number of participants with a negative RDT result who received antimalarials ranged from 0% to 81%.
Overall, RDT supported diagnosis had little or no effect on the number of participants remaining unwell at four to seven days after treatment (6990 participants, five trials, low quality evidence); but using RDTs reduced prescribing of antimalarials by up to three‐quarters (17,287 participants, seven trials, moderate quality evidence). As would be expected, the reduction in antimalarial prescriptions was highest where health workers adherence to the RDT result was high, and where the true prevalence of malaria was lower.
Using RDTs to support diagnosis did not have a consistent effect on the prescription of antibiotics, with some trials showing higher antibiotic prescribing and some showing lower prescribing in the RDT group (13,573 participants, five trials, very low quality evidence).
One trial reported malaria microscopy on all enrolled patients in an area of moderate endemicity, so we could compare the number of patients in the RDT and clinical diagnosis groups that actually had microscopy confirmed malaria infection but did not receive antimalarials. No difference was detected between the two diagnostic strategies (1280 participants, one trial, low quality evidence).
Authors' conclusions
Algorithms incorporating RDTs can substantially reduce antimalarial prescribing if health workers adhere to the test results. Introducing RDTs has not been shown to improve health outcomes for patients, but adherence to the test result does not seem to result in worse clinical outcomes than presumptive treatment.
Concentrating on improving the care of RDT negative patients could improve health outcomes in febrile children.
17 April 2019
Update pending
Studies awaiting assessment
The CIDG is currently examining a new search conducted up to 16 Aug, 2018 for potentially relevant studies. These studies have not yet been incorporated into this Cochrane Review.
Microbial cell free DNA sequencing is increasingly used for diagnosis of infection but few studies describe its utility in real-world settings. We performed a single-center retrospective case series ...of microbial cell free DNA testing using the Karius assay from 29 patient samples to define the clinical reasoning and the impact of testing. Indications fell into 3 categories, identifying a causative pathogen in patients with an infectious syndrome and negative microbiologic workup (15/29, 52%), seeking another pathogen when organisms identified by traditional diagnostics failed to explain the clinical presentation (9/29, 31%) and to “rule out” infection in patients with nonspecific symptoms and negative microbiologic workup (5/29, 17%). Clinical impact was positive in 13/29 (45%) and all were for patients with high pretest probability for infection. Impact was negative in 3/29 (10%) cases. There was no impact in 15/29 (52%) cases. Further work is needed to define the optimal timing accounting for test performance, and patient characteristics.
The production and use of malaria rapid diagnostic tests (RDTs) has risen dramatically over the past 20 years. In view of weak or non-existing in vitro diagnostics (IVD) regulations and ...post-marketing surveillance (PMS) systems in malaria endemic countries, the World Health Organization, later joined by the Foundation for Innovative New Diagnostics, established an independent, centralized performance evaluation and Lot Testing (LT) programme to safeguard against poor quality of RDTs being distributed through the public health sector of malaria endemic countries. RDT performances and manufacturer quality management systems have evolved over the past decade raising questions about the future need for a centralized LT programme.
Between 2007 and 2017, 6056 lots have been evaluated, representing approximately 1.6 Billion RDTs. A total of 69 lots (1.1%) failed the quality control. Of these failures, 26 were detected at receipt of the RDT lot in the LT laboratory, representing an estimated 7.9 million poor quality RDTs, and LT requesters were advised that RDTs were not of sufficient quality for use in patient management. Forty-three were detected after long-term storage in the laboratory, of which 24 (56%) were found to be due to a major issue with insufficient buffer volume in single use buffer vials, others predominantly showing loss of sensitivity. The annual cost of running the programme, based on expenses recorded in years 2014-2016, an estimated volume of 700 lots per year and including replenishment of quality control samples, was estimated at US$ 178,500 ($US 255 per lot tested).
Despite the clear benefits of the centralized LT programme and its low cost compared with the potential costs of each country establishing its own PMS system for RDTs, funding concerns have made its future beyond 2020 uncertain. In order to manage the risks of misdiagnosis due to low quality RDTs, and to ensure the continued safety and reliability of malaria case management, there is a need to ensure that an effective and implementable approach to RDT quality control continues to be available to programmes in endemic countries.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
The study of the edge plasma has significant effect for the performance improvement of magnetic confinement. However, the Thomson scattering system, which has been used to provide electron ...temperature and electron density on EAST, do not meet the requirements for the edge plasma measurements in measurement region, spatial and spectral resolution. Herein, a TV Thomson scattering diagnostic system has been constructed for the measurements of edge electron temperature and electron density profiles on EAST. A new laser system, optical collection system and data acquisition system are designed to enable the TV Thomson system operate at the measurement region of 0.65–1.1 ρ (“ρ” is the unitary radius in flux coordinate) with spectral resolution of 5 nm and spatial resolution as low as 2 mm. And the theoretical analysis proves that the system has the measurability at electron temperature of 20–1000 eV and density beyond 0.2 × 10
19
m
-3
, which fulfills research of the pedestal microstructure on EAST. The establishment of the edge TV Thomson system can create the conditions for the edge physical study on EAST.
Substandard (including degraded) and falsified (SF) vaccines are a relatively neglected issue with serious global implications for public health. This has been highlighted during the rapid and ...widespread rollout of COVID-19 vaccines. There has been increasing interest in devices to screen for SF non-vaccine medicines including tablets and capsules to empower inspectors and standardise surveillance. However, there has been very limited published research focussed on repurposing or developing new devices for screening for SF vaccines. To our knowledge, rapid diagnostic tests (RDTs) have not been used for this purpose but have important potential for detecting falsified vaccines. We performed a proof-in-principle study to investigate their diagnostic accuracy using a diverse range of RDT-vaccine/falsified vaccine surrogate pairs. In an initial assessment, we demonstrated the utility of four RDTs in detecting seven vaccines. Subsequently, the four RDTs were evaluated by three blinded assessors with seven vaccines and four falsified vaccines surrogates. The results provide preliminary data that RDTs could be used by multiple international organisations, national medicines regulators and vaccine manufacturers/distributors to screen for falsified vaccines in supply chains, aligned with the WHO global ‘Prevent, Detect and Respond’ strategy.
Background
Tuberculosis (TB) is the world’s leading infectious cause of death. Extrapulmonary TB accounts for 15% of TB cases, but the proportion is increasing, and over half a million people were ...newly diagnosed with rifampicin‐resistant TB in 2016. Xpert® MTB/RIF (Xpert) is a World Health Organization (WHO)‐recommended, rapid, automated, nucleic acid amplification assay that is used widely for simultaneous detection of Mycobacterium tuberculosis complex and rifampicin resistance in sputum specimens. This Cochrane Review assessed the accuracy of Xpert in extrapulmonary specimens.
Objectives
To determine the diagnostic accuracy of Xpert a) for extrapulmonary TB by site of disease in people presumed to have extrapulmonary TB; and b) for rifampicin resistance in people presumed to have extrapulmonary TB.
Search methods
We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature (LILACS), Scopus, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number (ISRCTN) Registry, and ProQuest up to 7 August 2017 without language restriction.
Selection criteria
We included diagnostic accuracy studies of Xpert in people presumed to have extrapulmonary TB. We included TB meningitis and pleural, lymph node, bone or joint, genitourinary, peritoneal, pericardial, and disseminated TB. We used culture as the reference standard. For pleural TB, we also included a composite reference standard, which defined a positive result as the presence of granulomatous inflammation or a positive culture result. For rifampicin resistance, we used culture‐based drug susceptibility testing or MTBDRplus as the reference standard.
Data collection and analysis
Two review authors independently extracted data, assessed risk of bias and applicability using the QUADAS‐2 tool. We determined pooled predicted sensitivity and specificity for TB, grouped by type of extrapulmonary specimen, and for rifampicin resistance. For TB detection, we used a bivariate random‐effects model. Recognizing that use of culture may lead to misclassification of cases of extrapulmonary TB as ‘not TB' owing to the paucibacillary nature of the disease, we adjusted accuracy estimates by applying a latent class meta‐analysis model. For rifampicin resistance detection, we performed univariate meta‐analyses for sensitivity and specificity separately to include studies in which no rifampicin resistance was detected. We used theoretical populations with an assumed prevalence to provide illustrative numbers of patients with false positive and false negative results.
Main results
We included 66 unique studies that evaluated 16,213 specimens for detection of extrapulmonary TB and rifampicin resistance. We identified only one study that evaluated the newest test version, Xpert MTB/RIF Ultra (Ultra), for TB meningitis. Fifty studies (76%) took place in low‐ or middle‐income countries. Risk of bias was low for patient selection, index test, and flow and timing domains and was high or unclear for the reference standard domain (most of these studies decontaminated sterile specimens before culture inoculation). Regarding applicability, in the patient selection domain, we scored high or unclear concern for most studies because either patients were evaluated exclusively as inpatients at tertiary care centres, or we were not sure about the clinical settings.
Pooled Xpert sensitivity (defined by culture) varied across different types of specimens (31% in pleural tissue to 97% in bone or joint fluid); Xpert sensitivity was > 80% in urine and bone or joint fluid and tissue. Pooled Xpert specificity (defined by culture) varied less than sensitivity (82% in bone or joint tissue to 99% in pleural fluid and urine). Xpert specificity was ≥ 98% in cerebrospinal fluid, pleural fluid, urine, and peritoneal fluid.
Xpert testing in cerebrospinal fluid
Xpert pooled sensitivity and specificity (95% credible interval (CrI)) against culture were 71.1% (60.9% to 80.4%) and 98.0% (97.0% to 98.8%), respectively (29 studies, 3774 specimens; moderate‐certainty evidence).
For a population of 1000 people where 100 have TB meningitis on culture, 89 would be Xpert‐positive: of these, 18 (20%) would not have TB (false‐positives); and 911 would be Xpert‐negative: of these, 29 (3%) would have TB (false‐negatives).
For TB meningitis, ultra sensitivity and specificity against culture (95% confidence interval (CI)) were 90% (55% to 100%) and 90% (83% to 95%), respectively (one study, 129 participants).
Xpert testing in pleural fluid
Xpert pooled sensitivity and specificity (95% CrI) against culture were 50.9% (39.7% to 62.8%) and 99.2% (98.2% to 99.7%), respectively (27 studies, 4006 specimens; low‐certainty evidence).
For a population of 1000 people where 150 have pleural TB on culture, 83 would be Xpert‐positive: of these, seven (8%) would not have TB (false‐positives); and 917 would be Xpert‐negative: of these, 74 (8%) would have TB (false‐negatives).
Xpert testing in urine
Xpert pooled sensitivity and specificity (95% CrI) against culture were 82.7% (69.6% to 91.1%) and 98.7% (94.8% to 99.7%), respectively (13 studies, 1199 specimens; moderate‐certainty evidence).
For a population of 1000 people where 70 have genitourinary TB on culture, 70 would be Xpert‐positive: of these, 12 (17%) would not have TB (false‐positives); and 930 would be Xpert‐negative: of these, 12 (1%) would have TB (false‐negatives).
Xpert testing for rifampicin resistance
Xpert pooled sensitivity (20 studies, 148 specimens) and specificity (39 studies, 1088 specimens) were 95.0% (89.7% to 97.9%) and 98.7% (97.8% to 99.4%), respectively (high‐certainty evidence).
For a population of 1000 people where 120 have rifampicin‐resistant TB, 125 would be positive for rifampicin‐resistant TB: of these, 11 (9%) would not have rifampicin resistance (false‐positives); and 875 would be negative for rifampicin‐resistant TB: of these, 6 (1%) would have rifampicin resistance (false‐negatives).
For lymph node TB, the accuracy of culture, the reference standard used, presented a greater concern for bias than in other forms of extrapulmonary TB.
Authors' conclusions
In people presumed to have extrapulmonary TB, Xpert may be helpful in confirming the diagnosis. Xpert sensitivity varies across different extrapulmonary specimens, while for most specimens, specificity is high, the test rarely yielding a positive result for people without TB (defined by culture). Xpert is accurate for detection of rifampicin resistance. For people with presumed TB meningitis, treatment should be based on clinical judgement, and not withheld solely on an Xpert result, as is common practice when culture results are negative.
2 April 2019
Up to date
All studies incorporated from most recent search
Updated review: all eligible published studies found in the last search (7 Aug, 2017) were included
Egg yolk constitutes a relevant alternative source of antibodies. It presents some advantages over mammalian serum immunoglobulins regarding productivity, animal welfare and specificity. The main ...immunoglobulin present in avian blood (IgY) is transmitted to their offspring and accumulates in egg yolks, which enables the non-invasive harvesting of high amounts of antibodies. Moreover, due to structural differences and phylogenetic distance, IgY is more suitable for diagnostic purposes than mammalian antibodies, since it does not react with certain components of the human immune system and displays greater avidity for mammalian conserved proteins. IgY has been extensively used in health researches, as both therapeutic and diagnostic tool. This article aims to review its applications in both human and veterinary health.
•IgY-technology is a new frontier for biological products•IgY Abs is a non-invasive technology obtained from egg yolks of immunized hens.•A wide range of IgY applications has been successfully tested in both human and animal health.•IgY technology constitutes a relevant alternative for the mammalian antibodies production.
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