SummaryBackgroundThe Xpert MTB/RIF assay is an automated molecular test that has improved the detection of tuberculosis and rifampicin resistance, but its sensitivity is inadequate in patients with paucibacillary disease or HIV. Xpert MTB/RIF Ultra (Xpert Ultra) was developed to overcome this limitation. We compared the diagnostic performance of Xpert Ultra with that of Xpert for detection of tuberculosis and rifampicin resistance.MethodsIn this prospective, multicentre, diagnostic accuracy study, we recruited adults with pulmonary tuberculosis symptoms presenting at primary health-care centres and hospitals in eight countries (South Africa, Uganda, Kenya, India, China, Georgia, Belarus, and Brazil). Participants were allocated to the case detection group if no drugs had been taken for tuberculosis in the past 6 months or to the multidrug-resistance risk group if drugs for tuberculosis had been taken in the past 6 months, but drug resistance was suspected. Demographic information, medical history, chest imaging results, and HIV test results were recorded at enrolment, and each participant gave at least three sputum specimen on 2 separate days. Xpert and Xpert Ultra diagnostic performance in the same sputum specimen was compared with culture tests and drug susceptibility testing as reference standards. The primary objectives were to estimate and compare the sensitivity of Xpert Ultra test with that of Xpert for detection of smear-negative tuberculosis and rifampicin resistance and to estimate and compare Xpert Ultra and Xpert specificities for detection of rifampicin resistance. Study participants in the case detection group were included in all analyses, whereas participants in the multidrug-resistance risk group were only included in analyses of rifampicin-resistance detection.FindingsBetween Feb 18, and Dec 24, 2016, we enrolled 2368 participants for sputum sampling. 248 participants were excluded from the analysis, and 1753 participants were distributed to the case detection group (n=1439) and the multidrug-resistance risk group (n=314). Sensitivities of Xpert Ultra and Xpert were 63% and 46%, respectively, for the 137 participants with smear-negative and culture-positive sputum (difference of 17%, 95% CI 10 to 24); 90% and 77%, respectively, for the 115 HIV-positive participants with culture-positive sputum (13%, 6·4 to 21); and 88% and 83%, respectively, across all 462 participants with culture-positive sputum (5·4%, 3·3 to 8·0). Specificities of Xpert Ultra and Xpert for case detection were 96% and 98% (−2·7%, −3·9 to −1·7) overall, and 93% and 98% for patients with a history of tuberculosis. Xpert Ultra and Xpert performed similarly in detecting rifampicin resistance.InterpretationFor tuberculosis case detection, sensitivity of Xpert Ultra was superior to that of Xpert in patients with paucibacillary disease and in patients with HIV. However, this increase in sensitivity came at the expense of a decrease in specificity.FundingGovernment of Netherlands, Government of Australia, Bill & Melinda Gates Foundati...

RESUMO: Este artigo tem como objetivo dar uma visão geral dos estudos existentes acerca do processo de viver da pessoa ostomizada. Para tal, foi efetuada uma revisão de literatura que deu especial enfoque às alterações fisiológicas, psico-emocionais e sociais que ocorrem após a intervenção, em relação às quais, é essencial que a pessoa se re-estruture, no sentido de manter sua integridade. O suporte familiar e o atendimento profissional personalizado são indispensáveis na adaptação da pessoa à sua nova condição. ABSTRACT:The purpose of this study is to give a general overview of existing studies concerning the life process of a person with a stoma. For such, a literature review was carried out with a special emphasis on physiological, psycho-emotional, and social alterations that occur after surgery; in which it is essential that the person reorganizes themselves in order to keep their integrity. Family support and personalized professional health care are indispensable for the person's adaptation to his/her new condition. RESUMEN:El objetivo del presente artículo es dar una visión general de los estudios existentes relativos al proceso de vivir de la persona ostomizada. Para tal fin, se efectuó una revisión bibliográfica, haciendo hincapié en las alteraciones fisiológicas, psico-emocionales y sociales que ocurren después de la intervención, con relación a las cuales es esencial que la persona se reestructure, en el sentido de mantener su integridad. El soporte familiar y la atención profesional personalizada son indispensables en la adaptación de la persona en su nueva condición. PALAVRAS-CHAVE:Ostomia. Impacto psicossocial. Adaptação.

We experimentally demonstrate a novel optical packet compression scheme based on linearly chirping the packets followed by dispersive compression and multiwavelength conversion back onto a single wavelength. In particular, four-bit packets at 10 Gb/s were compressed into four-bit packets at 40 Gb/s. Error-free performance was achieved for the final compressed packet.

We experimentally demonstrate the use of saw-tooth optical pulses, which are shaped using a fiber Bragg grating, to achieve robust and high performance time-domain add-drop multiplexing in a scheme based on cross-phase (XPM) modulation in an optical fiber, with subsequent offset filtering. As compared to the use of more conventional pulse shapes, such as Gaussian pulses of a similar pulse width, the purpose-shaped saw-tooth pulses allow higher extinction ratios for the add and drop windows and significant improvements in the receiver sensitivity for the dropped and added channels.