Tuberculosis diagnostics and biomarkers: needs, challenges, recent advances, and opportunities

Tuberculosis is unique among the major infectious diseases in that it lacks accurate rapid point-of-care diagnostic tests. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely fashion, allowing continued Mycobacterium tuberculosis transmission within communities. Currently recommended gold-standard diagnostic tests for tuberculosis are laboratory based, and multiple investigations may be necessary over a period of weeks or months before a diagnosis is made. Several new diagnostic tests have recently become available for detecting active tuberculosis disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. In the absence of effective prevention strategies, high rates of early case detection and subsequent cure are required for global tuberculosis control. Early case detection is dependent on test accuracy, accessibility, cost, and complexity, but also depends on the political will and funder investment to deliver optimal, sustainable care to those worst affected by the tuberculosis and human immunodeficiency virus epidemics. This review highlights unanswered questions, challenges, recent advances, unresolved operational and technical issues, needs, and opportunities related to tuberculosis diagnostics

Governança da educação na União Europeia: redes, dados e standards

The broad area of education in the European Union was generally seen as a national question and responsibility, an area of subsidiarity, but over time there is a convergence of policy across the nations. The EU does not command convergence; indeed, it is unable to, but it does govern the area of education of education at all stages more and more. The problem of governing, how it can operate and what tools to use, is an interesting case of an ambiguous area within the EU and about calling an area into creation so that it can be managed effectively and quietly. In doing so, the governing technologies that are used are of as much interest as the actual policies proposed and so are the range of actors who participate in the construction and regulation of European education. Complex networks of public and private experts, using new data technologies and producing analyses and new benchmarks and standards, are brought together through various funding schemes into a system of attraction and persuasion, soft governance. Significant numbers of professionals have been willingly producing new political technologies, including data systems and standards, and the complex material production of new systems of education, and incorporate political technology, data production, experts and labour processes. The system has worked well but is it more than just coping with the ordinary present?El ámbito de la educación en la Unión Europea (UE) generalmente se considera como una cuestión de responsabilidad nacional, un ámbito subsidiario, pero a lo largo del tiempo se ha producido una convergencia de políticas de las naciones. La UE no comanda esta convergencia; ni es capaz de hacerlo, pero, cada vez más, gobierna el área de la educación en todas las etapas. El problema de la gobernanza, cómo funciona y qué herramientas utiliza, es un caso interesante de un área ambigua dentro de la UE y de llamar un área a la creación para que pueda ser gestionada de manera eficaz y silenciosa. Al hacerlo, las tecnologías gubernamentales utilizadas son de interés como las políticas propuestas, así como la gama de actores que participan en la construcción y regulación de la educación europea. Las redes complejas de expertos públicos y privados, utilizando nuevas tecnologías de datos y produciendo análisis y nuevos benchmarks y estándares se reúnen a través de varios esquemas de financiamiento de un sistema de atracción y persuasión, soft governance (gobernanza suave). Un número significativo de profesionales han generado voluntariamente nuevas tecnologías políticas, incluyendo sistemas de datos y estándares, la compleja producción material de nuevos sistemas de educación, incorporan tecnología, producción de datos, expertos y procesos de trabajo. El sistema ha funcionado, pero ofrece algo más que sólo tratar con el ordinario presente?A área da educação na União Europeia (UE) geralmente é vista como uma questão e responsabilidade nacional, uma área subsidiária, mas ao longo do tempo foi ocorrendo uma convergência de políticas das nações. A UE não comanda esta convergência; nem é capaz de fazê-lo, mas, cada vez mais, governa a área da educação em todos os estágios. O problema da governança, como opera e que ferramentas utiliza, é um caso interessante de uma área ambígua dentro da UE e de chamar uma área à criação para que possa ser gerida de modo eficaz e silencioso. Ao fazê-lo, as tecnologias governamentais usadas são de interesse como as políticas propostas bem como a gama de atores que participam da construção e regulação da educação Europeia. Redes complexas de experts públicos e privados, usando novas tecnologias de dados e produzindo análises e novos benchmarks e standards são reunidos por meio de vários esquemas de financiamento de um sistema de atração e persuasão, soft governance [governança suave]. Um número significante de professionais tem voluntariamente produzido novas tecnologias políticas, incluindo sistemas de dados e standards, a complexa produção material de novos sistemas de educação, incorporam tecnologia, produção de dados, experts e processos de trabalho. O sistema tem funcionado, mas oferece algo mais do que apenas lidar com o ordinário presente

Organised teachers and the labour movement 1900-1930

This case study of organised teachers falls into three main parts. In the first section there is a discussion of the working conditions and problems of teaching which is followed by detailed histories of strikes in West Ham, Herefordshire and the Rhondda. These took place in the period between 1900 and 1919 and illustrate the build-up of tension between teachers and their employers culminating in the salaries campaign of 1916 to 1919. Strikes and disputes reveal in speeches,letters or articles the tensions which the teachers faced working in the education system and possible ways of resolving them.The second part of the study is concerned with ideas which influenced teachers in trying to solve the contradictions of work and solutions generated by the Board of Education in devising a reconstructed system of State education. Teachers adopted or redefined various socialist strands of thought common in the first two decades of the century, in particular Fabianism, guild socialism and syndicalism and were influenced by practical examples of socialist reconstruction proposed by the Independent Labour Party or Trade Councils. Strongly expressed definitions of duty and the responsibility of teachers to the State promoted, among others, by H.A.L. Fisher were also attempting to influence teachers.In the last section, newly formulated teacher demands for self government were opposed by a strong counter-attack from the Treasury and from the Board of Education on the teachers, which in turn, encouraged many local education authorities to break a national pay agreement and return to pre-war working conditions. Bitter strikes were fought with the help of a weakened Labour movement and a divided teaching force.The case study is an argument for generating new theoretical categories to understand or examine teachers and opposes the theoretical straitjacket commonly applied to teachers, drawn from social mobility theory or neo-Marxism

Drug-Resistant Tuberculosis--Current Dilemmas, Unanswered Questions, Challenges and Priority Needs

Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis–specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discussed

Tuberculosis incidence correlates with sunshine : an ecological 28-year time series study

Birmingham is the largest UK city after London, and central Birmingham has an annual tuberculosis incidence of 80 per 100,000. We examined seasonality and sunlight as drivers of tuberculosis incidence. Hours of sunshine are seasonal, sunshine exposure is necessary for the production of vitamin D by the body and vitamin D plays a role in the host response to tuberculosis. Methods: We performed an ecological study that examined tuberculosis incidence in Birmingham from Dec 1981 to Nov 2009, using publicly-available data from statutory tuberculosis notifications, and related this to the seasons and hours of sunshine (UK Meteorological Office data) using unmeasured component models. Results: There were 9,739 tuberculosis cases over the study period. There was strong evidence for seasonality, with notifications being 24.1% higher in summer than winter (p<0.001). Winter dips in sunshine correlated with peaks in tuberculosis incidence six months later (4.7% increase in incidence for each 100 hours decrease in sunshine, p<0.001). Discussion and Conclusion: A potential mechanism for these associations includes decreased vitamin D levels with consequent impaired host defence arising from reduced sunshine exposure in winter. This is the longest time series of any published study and our use of statutory notifications means this data is essentially complete. We cannot, however, exclude the possibility that another factor closely correlated with the seasons, other than sunshine, is responsible. Furthermore, exposure to sunlight depends not only on total hours of sunshine but also on multiple individual factors. Our results should therefore be considered hypothesis-generating. Confirmation of a potential causal relationship between winter vitamin D deficiency and summer peaks in tuberculosis incidence would require a randomized-controlled trial of the effect of vitamin D supplementation on future tuberculosis incidence

Outsourcing the Governing of Education: The Contemporary Inspection of Schooling in England

The schools inspection service in England has been privatised and private companies manage it, through contracts. These companies hire flexible and part time inspectors who may be led by a small number of permanent HM inspectors. This shift in the highly regulated inspection service has introduced new methods of operation, market based behaviours and commercial confidentiality into the education sector and contrasts with the older, elite, judgement-based advisory work of their predecessors. Knowledge is produced and used by new actors for new purposes. The outsourcing of school inspection is a significant step in governing education, and indicates a future development in its governing knowledge

The Understories of European Education: The Contemporary Life of Experts and Professionals

The European Space for Education exists in different forms; for example, as policy documents, regulations, projects, Ministers Meetings. In the last ten years or fifteen years, there has been an important growth in the work of experts and professionals, constructing the infrastructure of this Space. Their associations, created at a European level, are enmeshed and embedded in this work of construction. This is undramatic but essential work, and they have steadily engaged with the governance of Europe. But they live life in the shade, without summit meetings or media headlines, but with an essential place in the ecology of new European education

Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya

Despite innovations in HIV counseling and testing (HCT), important gaps remain in understanding linkage to care. We followed a cohort diagnosed with HIV through a community-based HCT campaign that trained persons living with HIV/AIDS (PLHA) as navigators. Individual, interpersonal, and institutional predictors of linkage were assessed using survival analysis of self-reported time to enrollment. Of 483 persons consenting to follow-up, 305 (63.2%) enrolled in HIV care within 3 months. Proportions linking to care were similar across sexes, barring a sub-sample of men aged 18–25 years who were highly unlikely to enroll. Men were more likely to enroll if they had disclosed to their spouse, and women if they had disclosed to family. Women who anticipated violence or relationship breakup were less likely to link to care. Enrolment rates were significantly higher among participants receiving a PLHA visit, suggesting that a navigator approach may improve linkage from community-based HCT campaigns.Vestergaard Frandse

Drug-Resistant Tuberculosis—Current Dilemmas, Unanswered Questions, Challenges, and Priority Needs

Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis-specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discusse