ABSTRACT
BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.
Subject(s)
Tuberculosis, Meningeal , Adolescent , Child , Humans , Tuberculosis, Meningeal/drug therapy , Standard of Care , Delphi Technique , Practice Guidelines as TopicABSTRACT
This study focused on the impact of a recent soil pollution of diesel fuel on a site and its indigenous microbial flora. A pilot plant (0.5 m3) was set up and filled with a soil (about 700 kg), artificially and uniformly polluted with diesel fuel (7 g/kg). This plant was then chemically and biologically monitored during the whole experiment (about two years). During the monitoring, a morphological change of the microbial colonies was observed. This was probably due to the acclimation phenomena to the pollution. With batch kinetic studies (10 ml) and increasing the selective pressure of the pollutant, it was possible to select and isolate a microbial consortium and a single strain that developed the ability to use different diesel fuel fractions as carbon sources. GC-MS analytical techniques were used. Results showed that different fractions were degraded at different times. In the batch system, in 7 days, the microbial consortium degraded some aromatic hydrocarbons. The isolate strain, in 20 days, degraded linear hydrocarbons. After a two years acclimation, it was possible to obtain, from a pilot plant, a microbial consortium and a strain able to degrade diesel fuel, for a future bioremediation in situ process.
Subject(s)
Carcinogens, Environmental/adverse effects , Gasoline/adverse effects , Soil Microbiology , Soil Pollutants/adverse effects , Acclimatization , Biodegradation, Environmental , Carcinogens, Environmental/metabolism , Environmental Monitoring , Population Dynamics , Soil Pollutants/metabolismABSTRACT
Research activities carried out at ENEA during the last few years allowed development of a Sequencing Batch Reactor (SBR) that is able to remove biologically organic waste, nitrogen and phosphorus and that showed to be particularly suited to obtain low effluent nutrient concentrations even starting from concentrated wastes. This plant, in more than one year of operation, is quite steadily obtaining more than 98% removal of nitrogen, phosphorus and COD. On the basis of the experimental results, a simulation model has been built and calibrated. The model showed the potential to be used for forecasting the behaviour of the process, being able to reproduce a process imbalance that followed the tentative reduction of aeration time.
Subject(s)
Bioreactors , Industrial Waste , Waste Disposal, Fluid/methods , Animal Husbandry , Animals , Italy , Models, Theoretical , Nitrogen/isolation & purification , Organic Chemicals/isolation & purification , Phosphorus/isolation & purification , SwineABSTRACT
Post-treatments are necessary if anaerobic effluents need to be discharged into surface waters, because anaerobic digestion alone is not able to produce effluents that can meet the discharge standards applied in most industrialized countries, particularly for suspended solids, particulate COD, nitrogen, phosphorus and sulphides. This paper has the aim to present some results obtained in the recent years in our laboratory, where different comprehensive processes that include anaerobic digestion have been studied. Discussion will regard: 1) the ANANOX (ANaerobic-ANoxic-OXic) process for the treatment of municipal wastewater; 2) a process studied for the biological removal of C, N and P from piggery wastewater that has a hybrid anaerobic/anoxic reactor as the first treatment step; 3) the use of a Sequencing Batch Reactor for the post-treatment of digested cheese whey mixed with cheese factory cleaning waters.
Subject(s)
Biodegradation, Environmental , Waste Disposal, Fluid/methods , Anaerobiosis , Animal Husbandry , Animals , Biotechnology , Carbon/metabolism , Cheese , Food-Processing Industry , Nitrogen/metabolism , Phosphorus/metabolism , Sanitary Engineering , Swine , Waste Disposal, Fluid/instrumentation , Water Pollutants, Chemical/metabolismABSTRACT
Stereotactic radiotherapy to treat neoplastic lesions or artero-venus malformations in the brain may be accomplished with a linear accelerator by performing several non-coplanar arcs of irradiation with a highly collimated beam focused on a fixed point. This paper introduces a system to perform treatment planning. It is based on a Personal Computer and allows the acquisition, reconstruction and visualization of the target volume, within the brain, from CT (Computerized Tomography) or MR (Magnetic Resonance) images, and then it permits calculation and visualization of a 3-D (three-dimensional) dose distribution due to small photon beams. The performances of the system and its use in a practical case are described.
Subject(s)
Brain Neoplasms/surgery , Radiosurgery , Radiotherapy Planning, Computer-Assisted , Humans , Radiotherapy DosageABSTRACT
The biological response of the tumor is expressed in terms of tumor control probability (TCP) and its dependence on the inhomogeneous dose distribution throughout the tumor volume is studied. The ideal dose level to which the prescribed dose must be referred is derived, by employing a formula based on the linear quadratic model. To administer the prescribed dose to the ideal dose level renders the tumor control probability equal to that one corresponding to a uniform irradiation of the tumor. For the normal tissue irradiated a normal tissue complication probability index (NTCPI) is also defined and calculated. The comparison between NTCPIs of competing plans supports the optimization. In general the resulting ideal dose level is lower than the mean dose level, but not necessarily equal to the minimum in the tumor. This result shows the possibility of administering the prescribed dose to a dose level higher than the minimum, maintaining the tumor control probability at a good level and consequently lowering the complications to the normal tissue. The method offers a general support for the choice of the reference dose level and of the better technique. An example of application of the method is shown.
