The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA: a systematic review

Background Migrants account for a large and growing proportion of tuberculosis (TB) cases in low-incidence countries in the European Union/European Economic Area (EU/EEA) which are primarily due to reactivation of latent TB infection (LTBI). Addressing LTBI among migrants will be critical to achieve TB elimination. Methods: We conducted a systematic review to determine effectiveness (performance of diagnostic tests, efficacy of treatment, uptake and completion of screening and treatment) and a second systematic review on cost-effectiveness of LTBI screening programmes for migrants living in the EU/EEA. Results: We identified seven systematic reviews and 16 individual studies that addressed our aims. Tuberculin skin tests and interferon gamma release assays had high sensitivity (79%) but when positive, both tests poorly predicted the development of active TB (incidence rate ratio: 2.07 and 2.40, respectively). Different LTBI treatment regimens had low to moderate efficacy but were equivalent in preventing active TB. Rifampicin-based regimens may be preferred because of lower hepatotoxicity (risk ratio = 0.15) and higher completion rates (82% vs 69%) compared with isoniazid. Only 14.3% of migrants eligible for screening completed treatment because of losses along all steps of the LTBI care cascade. Limited economic analyses suggest that the most cost-effective approach may be targeting young migrants from high TB incidence countries. Discussion: The effectiveness of LTBI programmes is limited by the large pool of migrants with LTBI, poorly predictive tests, long treatments and a weak care cascade. Targeted LTBI programmes that ensure high screening uptake and treatment completion will have greatest individual and public health benefit

Clostridium perfringens in London, July 2009: two weddings and an outbreak

Food poisoning outbreaks caused by Clostridium perfringens enterotoxin occur occasionally in Europe but have become less common in recent years. This paper presents the microbiological and epidemiological results of a large C. perfringens outbreak occurring simultaneously at two weddings that used the same caterer. The outbreak involved several London locations and required coordination across multiple agencies. A case-control study (n=134) was carried out to analyse possible associations between the food consumed and becoming ill. Food, environmental and stool samples were tested for common causative agents, including enterotoxigenic C. perfringens. The clinical presentation and the epidemiological findings were compatible with C. perfringens food poisoning and C. perfringens enterotoxin was detected in stool samples from two cases. The case-control study found statistically significant associations between becoming ill and eating either a specific chicken or lamb dish prepared by the same food handler of the implicated catering company. A rapid outbreak investigation with preliminary real-time results and the successful collaboration between the agencies and the caterer led to timely identification and rectification of the failures in the food handling practices

Oxygen superstructures throughout the phase diagram of (Y,Ca)Ba2Cu3O6+x\bf (Y,Ca)Ba_2 Cu_3 O_{6+x}

Short-range lattice superstructures have been studied with high-energy x-ray diffuse scattering in underdoped, optimally doped, and overdoped $\rm (Y,Ca)Ba_2 Cu_3 O_{6+x}$. A new four-unit-cell superstructure was observed in compounds with $x\sim 0.95$. Its temperature, doping, and material dependence was used to attribute its origin to short-range oxygen vacancy ordering, rather than electronic instabilities in the $\rm CuO_2$ layers. No significant diffuse scattering is observed in YBa$_2$Cu$_4$O$_{8}$. The oxygen superstructures must be taken into account when interpreting spectral anomalies in $\rm (Y,Ca)Ba_2 Cu_3 O_{6+x}$

VLBA Continuum and H I Absorption Observations of the Ultra-Luminous Infrared Galaxy IRAS 17208-0014

We present phase-referenced VLBI observations of the radio continuum emission from, and the neutral hydrogen 21 cm absorption toward, the Ultra-Luminous Infrared Galaxy IRAS 17208-0014. The observations were carried out at 1362 MHz using the Very Long Baseline Array, including the phased Very Large Array as an element. The high-resolution radio continuum images reveal a nuclear starburst region in this galaxy, which is composed of diffuse emission approximately 670 x 340 pc on the plane of the sky, and a number of compact sources. These sources are most likely to be clustered supernova remnants and/or luminous radio supernovae. Their brightness temperatures range over (2.2-6.6) x 10^{5} K, with radio spectral luminosities between (1-10) x 10^{21} W Hz^{-1}. The total VLBI flux density of the starburst region is ~52 mJy, which is about 50% of the total flux density detected with the VLA at arcsecond resolution. For this galaxy, we derive a massive star formation rate of ~84pm13 M{_\odot} yr^{-1}, and a supernova rate of ~4pm1 yr^{-1}. H I absorption is detected in multiple components with optical depths ranging between 0.3 and 2.5, and velocity widths between 58 and 232 km s^{-1}. The derived column densities, assuming T_{s}=100 K, range over (10-26) x 10^{21} cm^{-2}. The H I absorption shows a strong velocity gradient of 453 km s^{-1} across 0.36 arcsec (274 pc). Assuming Keplerian motion, the enclosed dynamical mass is about 2.3 x 10^9 sin^{-2}i M{_\odot}, comparable to the enclosed dynamical mass estimated from CO observations.Comment: 26 pages total, 6 figures. ApJ accepted. To appear in the April 1, 2003 issue of ApJ. For a version with better images, see http://www.aoc.nrao.edu/~emomjian/IRAS.p

Neutrino Spin Transitions and the Violation of the Equivalence Principle

The violation of the equivalence principle (VEP) causing neutrino oscillations is of current interest. We study here the possibility of not only flavor oscillation but spin flavor oscillation of ultra high energy ($\sim$ 1 PeV) neutrinos emanating from AGN due to VEP and due to the presence of a large magnetic field ($\sim$ 1 Tesla) in AGN. In particular we look at the resonance spin flavor conversion driven by the AGN potential. Interesting bounds on the transition magnetic moment of neutrinos may therefore be obtained.Comment: Latex, 12 pages, no figures. To appear in Journal of Physics G: Nuclear and Particle Physics. Two references adde

Dynamics of the Destruction and Rebuilding of a Dipole Gap in Glasses

After a strong electric bias field was applied to a glass sample at temperatures in the millikelvin range its AC-dielectric constant increases and then decays logarithmically with time. For the polyester glass mylar we have observed the relaxation of the dielectric constant back to its initial value for several temperatures and histories of the bias field. Starting from the dipole gap theory we have developed a model suggesting that the change of the dielectric constant after transient application of a bias field is only partly due to relaxational processes. In addition, non-adiabatic driving of tunneling states (TSs) by applied electric fields causes long lasting changes in the dielectric constant. Moreover, our observations indicate that at temperatures below 50 mK the relaxation of TSs is caused primarily by interactions between TSs.Comment: 4 pages, 4 figures, submitted to PR

Rotating Nuclear Rings and Extreme Starbursts in Ultraluminous Galaxies

New high resolution interferometer data of 10 IR ultraluminous galaxies shows the molecular gas is in rotating nuclear rings or disks with radii 300 to 800 pc. Most of the CO flux comes from a moderate-density, warm, intercloud medium rather than self-gravitating clouds. Gas masses of ~ 5 x 10^9 Msun, 5 times lower than the standard method are derived from a model of the molecular disks. The ratio of molecular gas to dynamical mass, is M_gas/M_dyn ~ 1/6 with a maximum ratio of gas to total mass surface density of 1/3. For the galaxies VIIZw31, Arp193, and IRAS 10565+24, there is good evidence for rotating molecular rings with a central gap. In addition to the rotating rings a new class of star formation region is identified which we call an Extreme Starburst. They have a characteristic size of only 100 pc., about 10^9 Msun of gas and an IR luminosity of ~3 x 10^11 Lsun. Four extreme starbursts are identified in the 3 closest galaxies in the sample Arp220, Arp193 and Mrk273. They are the most prodigious star formation events in the local universe, each representing about 1000 times as many OB stars as 30 Doradus. In Arp220, the CO and 1.3 mm continuum maps show the two ``nuclei'' embedded in a central ring or disk and a fainter structure extending 3 kpc to the east, normal to the nuclear disk. There is no evidence that these sources really are the pre-merger nuclei. They are compact, extreme starburst regions containing 10^9 Msun of dense molecular gas and new stars, but no old stars. Most of the dust emission and HCN emission arises in the two extreme starbursts. The entire bolometric luminosity of Arp~220 comes from starbursts, not an AGN. In Mrk231, the disk geometry shows that the molecular disk cannot be heated by the AGN; the far IR luminosity of Mrk~231 is powered by a starburst, not the AGN. (Abridged)Comment: 97 pages Latex with aasms.sty, including 29 encapsulated Postscript figures. Figs 18 and 23 are GIFs. 31 figures total. Text and higher quality versions of figures available at http://sbastk.ess.sunysb.edu/www/RINGS_ESB_PREPRINT.html To be published in Ap. J., 10 Nov. 199

The Structure of IR Luminous Galaxies at 100 Microns

We have observed twenty two galaxies at 100 microns with the Kuiper Airborne Observatory in order to determine the size of their FIR emitting regions. Most of these galaxies are luminous far-infrared sources, with L_FIR > 10^11 L_sun. This data constitutes the highest spatial resolution ever achieved on luminous galaxies in the far infrared. Our data includes direct measurements of the spatial structure of the sources, in which we look for departures from point source profiles. Additionally, comparison of our small beam 100 micron fluxes with the large beam IRAS fluxes shows how much flux falls beyond our detectors but within the IRAS beam. Several sources with point- like cores show evidence for such a net flux deficit. We clearly resolved six of these galaxies at 100 microns and have some evidence for extension in seven others. Those galaxies which we have resolved can have little of their 100 micron flux directly emitted by a point-like active galactic nucleus (AGN). Dust heated to ~40 K by recent bursts of non-nuclear star formation provides the best explanation for their extreme FIR luminosity. In a few cases, heating of an extended region by a compact central source is also a plausible option. Assuming the FIR emission we see is from dust, we also use the sizes we derive to find the dust temperatures and optical depths at 100 microns which we translate into an effective visual extinction through the galaxy. Our work shows that studies of the far infrared structure of luminous infrared galaxies is clearly within the capabilities of new generation far infrared instrumentation, such as SOFIA and SIRTF.Comment: 8 tables, 23 figure