BackgroundDetermine-TB LAM assay is a urine point-of-care test useful for TB diagnosis in HIV-positive patients. We assessed the incremental diagnostic yield of adding LAM to algorithms based on clinical signs, sputum smear-microscopy, chest X-ray and Xpert MTB/RIF in HIV-positive patients with symptoms of pulmonary TB (PTB).MethodsProspective observational cohort of ambulatory (either severely ill or CD4<200cells/μl or with Body Mass Index<17Kg/m2) and hospitalized symptomatic HIV-positive adults in Kenya. Incremental diagnostic yield of adding LAM was the difference in the proportion of confirmed TB patients (positive Xpert or MTB culture) diagnosed by the algorithm with LAM compared to the algorithm without LAM. The multivariable mortality model was adjusted for age, sex, clinical severity, BMI, CD4, ART initiation, LAM result and TB confirmation.ResultsAmong 474 patients included, 44.1% were severely ill, 69.6% had CD4<200cells/μl, 59.9% had initiated ART, 23.2% could not produce sputum. LAM, smear-microscopy, Xpert and culture in sputum were positive in 39.0% (185/474), 21.6% (76/352), 29.1% (102/350) and 39.7% (92/232) of the patients tested, respectively. Of 156 patients with confirmed TB, 65.4% were LAM positive. Of those classified as non-TB, 84.0% were LAM negative. Adding LAM increased the diagnostic yield of the algorithms by 36.6%, from 47.4% (95%CI:39.4–55.6) to 84.0% (95%CI:77.3–89.4%), when using clinical signs and X-ray; by 19.9%, from 62.2% (95%CI:54.1–69.8) to 82.1% (95%CI:75.1–87.7), when using clinical signs and microscopy; and by 13.4%, from 74.4% (95%CI:66.8–81.0) to 87.8% (95%CI:81.6–92.5), when using clinical signs and Xpert. LAM positive patients had an increased risk of 2-months mortality (aOR:2.7; 95%CI:1.5–4.9).ConclusionLAM should be included in TB diagnostic algorithms in parallel to microscopy or Xpert request for HIV-positive patients either ambulatory (severely ill or CD4<200cells/μl) or hospitalized. LAM allows same day treatment initiation in patients at higher risk of death and in those not able to produce sputum.

Implementing the TST for IPT initiation was feasible and acceptable in both urban and rural resource-constrained settings. This strategy allows patients who can benefit the most to receive long-term IPT and avoids unnecessarily treating a significant number of patients who do not stand to benefit.

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The technology of cold ironing (or shore-to-ship power) can meaningfully reduce greenhouse gases and air pollutant emissions from ships at the berth by powering the vessels from the electrical shore grid. While cold ironing constitutes an effective and affordable solution in northern Europe and America, economic, legal, and environmental factors still render this technology less attractive in southern Europe. This paper aims to unpack and analyze the economic, regulatory, and environmental factors that can foster cold ironing as a standard installation in the Mediterranean Sea. Based on a model design for the port of Trieste (Italy) as applied to a cluster of target ports in the Adriatic Sea (in Italy, Croatia, and Greece), this article evaluates the cold ironing payback period by comparing costs of shore side-plants with environmental externalities and O&M costs. Moreover, the paper addresses key regulatory bottlenecks arising in different European jurisdictions with regard to the setting-up and development of cold ironing, while appraising the legal and economic consequences of deploying cold ironing in light of the future inclusion of the maritime sector in the EU Emission Trading System.

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Recovery of fine non-ferrous metals from waste streams is a notoriously difficult problem in eddy current separation technology. Existing processes either have a low capacity or an incomplete recovery for particle sizes below 5 mm. In a new process, the particles are fed slightly wet to make them stick to the surface of the conveyor belt. The action of the magnet rotor makes the non-ferrous particles tumble, so that they break loose from the belt and end up in front of the rotor. The new process combines a relatively high capacity with an almost complete recovery, even for heavy and poorly conducting non-ferrous metals.