India has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world's "missing" patients, which includes those who may not have received effective TB care and could ...potentially spread TB to others. The "cascade of care" is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions.
The care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India's TB patients. We define the TB cascade as including the following patient populations: total prevalent active TB patients in India, TB patients who reach and undergo evaluation at RNTCP diagnostic facilities, patients successfully diagnosed with TB, patients who start treatment, patients retained to treatment completion, and patients who achieve 1-y recurrence-free survival. We estimate each step of the cascade for 2013 using data from two World Health Organization (WHO) reports (2014-2015), one WHO dataset (2015), and three RNTCP reports (2014-2016). In addition, we conduct three targeted systematic reviews of the scientific literature to identify 39 unique articles published from 2000-2015 that provide additional data on five indicators that help estimate different steps of the TB cascade. We construct separate care cascades for the overall population of patients with active TB and for patients with specific forms of TB-including new smear-positive, new smear-negative, retreatment smear-positive, and multidrug-resistant (MDR) TB. The WHO estimated that there were 2,700,000 (95%CI: 1,800,000-3,800,000) prevalent TB patients in India in 2013. Of these patients, we estimate that 1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%) were successfully diagnosed; 1,417,838 (53%) got registered for treatment; 1,221,764 (45%) completed treatment; and 1,049,237 (95%CI: 1,008,775-1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal outcome of 1-y recurrence-free survival. The separate cascades for different forms of TB highlight different patterns of patient attrition. Pretreatment loss to follow-up of diagnosed patients and post-treatment TB recurrence were major points of attrition in the new smear-positive TB cascade. In the new smear-negative and MDR TB cascades, a substantial proportion of patients who were evaluated at RNTCP diagnostic facilities were not successfully diagnosed. Retreatment smear-positive and MDR TB patients had poorer treatment outcomes than the general TB population. Limitations of our analysis include the lack of available data on the cascade of care in the private sector and substantial uncertainty regarding the 1-y period prevalence of TB in India.
Increasing case detection is critical to improving outcomes in India's TB cascade of care, especially for smear-negative and MDR TB patients. For new smear-positive patients, pretreatment loss to follow-up and post-treatment TB recurrence are considerable points of attrition that may contribute to ongoing TB transmission. Future multisite studies providing more accurate information on key steps in the public sector TB cascade and extension of this analysis to private sector patients may help to better target interventions and resources for TB control in India.
The cascade of care is a model for evaluating patient retention across sequential stages of care required to achieve a successful treatment outcome. This approach was first used to evaluate HIV care ...and has since been applied to other diseases. The tuberculosis (TB) community has only recently started using care cascade analyses to quantify gaps in quality of care. In this article, we describe methods for estimating gaps (patient losses) and steps (patients retained) in the care cascade for active TB disease. We highlight approaches for overcoming challenges in constructing the TB care cascade, which include difficulties in estimating the population-level burden of disease and the diagnostic gap due to the limited sensitivity of TB diagnostic tests. We also describe potential uses of this model for evaluating the impact of interventions to improve case finding, diagnosis, linkage to care, retention in care, and post-treatment monitoring of TB patients.
The breakup of the supercontinent Gondwanaland into Africa, Antarctica, Australia and India about 140 million years ago, and consequently the opening of the Indian Ocean, is thought to have been ...caused by heating of the lithosphere from below by a large plume whose relicts are now the Marion, Kerguelen and Réunion plumes. Plate reconstructions based on palaeomagnetic data suggest that the Indian plate attained a very high speed (18-20 cm yr(-1) during the late Cretaceous period) subsequent to its breakup from Gondwanaland, and then slowed to approximately 5 cm yr(-1) after the continental collision with Asia approximately 50 Myr ago. The Australian and African plates moved comparatively less distance and at much lower speeds of 2-4 cm yr(-1) (refs 3-5). Antarctica remained almost stationary. This mobility makes India unique among the fragments of Gondwanaland. Here we propose that when the fragments of Gondwanaland were separated by the plume, the penetration of their lithospheric roots into the asthenosphere were important in determining their speed. We estimated the thickness of the lithospheric plates of the different fragments of Gondwanaland around the Indian Ocean by using the shear-wave receiver function technique. We found that the fragment of Gondwanaland with clearly the thinnest lithosphere is India. The lithospheric roots in South Africa, Australia and Antarctica are between 180 and 300 km deep, whereas the Indian lithosphere extends only about 100 km deep. We infer that the plume that partitioned Gondwanaland may have also melted the lower half of the Indian lithosphere, thus permitting faster motion due to ridge push or slab pull.
There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a ...high degree of heterogeneity.
To estimate the prevalence of TB among the tribal populations in India.
A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old.
Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening.
A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 95% CI: 496-754 in the central zone and least 153 95% CI: 24-281 in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 95% CI: 504-1101 and Jammu and Kashmir the lowest 127 95% CI: 0-310 per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m2, h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever.
The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs.
Community based tuberculosis (TB) prevalence surveys in ten sites across India during 2006-2012.
To re-analyze data of recent sub-national surveys using uniform statistical methods and obtain a ...pooled national level estimate of prevalence of TB.
Individuals ≥15 years old were screened by interview for symptoms suggestive of Pulmonary TB (PTB) and history of anti-TB treatment; additional screening by chest radiography was undertaken in five sites. Two sputum specimens were examined by smear and culture among Screen-positives. Prevalence in each site was estimated after imputing missing values to correct for bias introduced by incompleteness of data. In five sites, prevalence was corrected for non-screening by radiography. Pooled prevalence of bacteriologically positive PTB was estimated using Random Effects Model after excluding data from one site. Overall prevalence of TB (all ages, all types) was estimated by adjusting for extra-pulmonary TB and Pediatric TB.
Of 769290 individuals registered, 715989 were screened by interview and 294532 also by radiography. Sputum specimen were examined from 50 852 individuals. Estimated prevalence of smear positive, culture positive and bacteriologically positive PTB varied between 108.4-428.1, 147.9-429.8 and 170.8-528.4 per 100000 populations in different sites. Pooled estimate of prevalence of bacteriologically positive PTB was 350.0 (260.7, 439.0). Overall prevalence of TB was estimated at 300.7 (223.7-377.5) in 2009, the mid-year of surveys. Prevalence was significantly higher in rural compared to urban areas.
TB burden continues to be high in India suggesting further strengthening of TB control activities.
Objectives/Hypothesis:
To review the medical literature evidence of potential risk factors for sudden sensorineural hearing loss (SSNHL) in the adult general population.
Study Design:
Systematic ...review of prospective and retrospective studies; meta‐analysis of case‐controlled studies.
Methods:
Three researchers independently reviewed MEDLINE (January 1, 1950–November 30, 2010), Embase (January 1, 1980–November 30, 2010), and Evidence‐Based Medicine Reviews databases in addition to conducting a manual reference search. Randomized controlled trials, prospective cohort studies, consecutive/nonconsecutive case series, and retrospective reviews in which a clear definition of SSNHL was stated were included in the study. Researchers individually extracted data regarding patient information and the presumed risk factors. Discrepancies were resolved by mutual consensus.
Results:
Twenty‐two articles met the inclusion criteria. Cardiovascular risk factors (smoking, increased alcohol consumption) appeared to be associated with a higher risk of developing SSNHL. A low level of serum folate may also be implicated as a risk factor. Factor V Leiden and MTHFR gene polymorphisms were found to occur more frequently in patients with SSNHL in several studies, suggesting these inherited prothrombophilic mutations could be independent risk factors of SSNHL.
Conclusions:
Acquired and inherited cardiovascular risk factors appeared to be associated with an increased risk of developing SSNHL.
BackgroundIt is well known that visual impairment (VI) has a detrimental effect on Quality of Life (QoL) in adults. Little is known about the effects of VI in childhood.AimsTo evaluate the effects of ...VI on QoL of children. To the authors' knowledge, this is the first study containing a comparison arm for children with VI.MethodsQoL in children with VI (n=24, age 10.13±2.89, 18 male, 6 female) was compared with an age-matched comparison group (n=24, age 9.83±2.81, 18 male, 6 female) using the Low Vision Quality of Life Questionnaire. Factors (distance and near visual acuity and age) that could be used as predictors of QoL were assessed. These were measured with standard clinical tests.ResultsChildren with VI had significantly lower QoL scores than the comparison group (p<0.001), resulting in a 35.6% reduction in total QoL score. QoL scores in children with VI were correlated with distance and near visual acuity (p<0.05). 38% of the variance could be predicted by these factors and age.ConclusionsConsideration of the effects of this reduced QoL must be made. Further studies are needed to establish the benefit to QoL of different habilitation strategies.
Parameters estimation is important in fuel cell modelling and it remains a challenging task to predict. One of the most discussed parameters is the water diffusion coefficient in Nafion® membrane, ...which has a huge variation (10−9 and 10−5 cm2 s−1), based upon the viewpoints of different authors. In this article, the estimation of the effective water diffusion coefficient through water balance method is presented and the effects of relative humidity gradient and cell temperature are explained. The membrane used in this work is Nafion® NRE 211 tested at a temperature of 60°C and 70°C with air flows. The value of water flux passing through the membrane is used to calculate the effective diffusion coefficient. A value in the range of 1 × 10−7 to 4 × 10−7 cm2 s−1 is reported and it shows that the water balance method can be applied easily to measure an effective membrane water diffusion coefficient.
Feed is one of the major inputs in aquaculture system and constitutes 60%–80% of total production costs of tilapia. Inappropriate selection of feed quality and the feeding strategy affects the feed ...utilization resulting in high food conversion ratio (FCR). A 60 days experiment was conducted to evaluate the growth performance and immuno-physiological responses of GIFT tilapia, (Oreochromis niloticus) by pulsed feeding under biofloc culture system in inland saline water. For the experiment, feeding pattern in pulsed was followed viz., in situ biofloc with daily feeding (T1), in situ biofloc with alternate day feeding (T2), in situ biofloc with every third day feeding (T3), in situ biofloc with no feeding (T4), and clear water control with daily feeding (C) each in triplicates. Biofloc based treatment receiving daily feeding (T1) resulted in significantly (P<0.05) higher average body weight, weight gain, and specific growth rate (SGR) compared to control. T1 and C showed a significantly similar feed conversion ratio (FCR) and protein efficiency ratio (PER). Fish maintained in T4 grew the least and survival was lowest (85%). The immunological parameters showed a significant difference (P<0.05) for nitroblue tetrazolium (NBT) and myeloperoxidase content whereas no significant difference (P>0.05) for lysozyme activity was observed. Higher NBT activity was observed in biofloc based treatments compared to control. Activity of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activity were considerably higher (P<0.05) in biofloc based treatments than control. Among biofloc based treatments the antioxidant activities were lower in T1. The carbohydrate metabolism enzymes lactate dehydrogenase (LDH) and malate dehydrogenase (MDH) were lower in T1, T2, and T3 compared to control and T4. In conclusion, in-situ biofloc with daily feeding is found to be effective in growth improvement and to elicit immune-physiological responses in GIFT tilapia under pulsed feeding using biofloc based system.
Objective
To determine the carbon savings potential of incorporating virtual care into surgical care pathways for pediatric patients with obstructive sleep apnea or otitis media with effusion.
...Methods
Pediatric patients with obstructive sleep apnea or otitis media with effusion were not enrolled, instead, a modeling cohort study design was used. This study utilized the British Columbia healthcare system and geography to model emissions. Care pathways were developed for pediatric patients with obstructive sleep apnea or otitis media with effusion requiring care at a tertiary pediatric center. Home addresses were located at the geographical center of the two most populated municipalities within each of the 10 most populated regional districts in 2020. Virtual visits replaced up to three clinically equivalent in‐person visits. Emissions (kgCO2e) for transport and virtual visits were estimated. Population‐weighted means and descriptive statistics were calculated.
Results
Utilizing 1, 2, or 3 virtual visits in the obstructive sleep apnea care pathway yielded potential emissions savings of 19.9%, 39.9%, and 59.8% respectively. Integrating 1, 2, or 3 virtual visits into the otitis media with effusion care pathway produced potential emissions savings of 16.6%, 33.2%, and 49.7%, respectively. Integrating 3 virtual visits can save up to 2156.8 kgCO2e per patient.
Conclusions
Appropriately conducting up to 50% of clinical encounters virtually for children with obstructive sleep apnea or otitis media with effusion reduced theoretical carbon emissions. For a single child, emission savings could reach over 2150 kgCO2e.
Level of Evidence
Level 5.
Appropriately conducting up to 50% of clinical encounters virtually for children with obstructive sleep apnea or otitis media with effusion substantially reduced theoretical carbon emissions. Virtual health can offer many benefits to patients, the healthcare system, and the environment, and should be encouraged in situations where in‐person and virtual visits are clinically equivalent whilst taking patient experience and health equity into consideration.
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