Disposable FFP2 and Type IIR Medical-Grade Face Masks: An Exhaustive Analysis into the Leaching of Micro- and Nanoparticles and Chemical Pollutants Linked to the COVID-19 Pandemic.

The COVID-19 pandemic has increased the worldwide production and use of disposable plastic face masks (DPFMs). The release of micro- and nanopollutants into the environment is one of the impacts derived from regulated and unregulated disposal of DPFMs. This study focuses on the emission of pollutants from medical-grade DPFMs when submerged in deionized water, simulating regulated and unregulated disposal of these masks. Three brands of FFP2 and three brands of Type IIR medical masks, produced in various countries (UK, EU, and non-EU), were investigated. Field emission gun scanning electron microscopy (FEG-SEM) was used to obtain high-resolution images of the micro- and nanoparticles, and 0.02 µm pore size inorganic membranes were used to retain and subsequently analyze smaller particle size nanoparticles (>20 nm) released from the DPFMs. Particles and fibers in the micro- and nanoscale were found in all six DPFM brands. SEM with energy-dispersive spectroscopy analysis revealed the presence of particles containing different heavy metals like lead, mercury, and arsenic. Inductively coupled plasma mass spectrometry analysis confirmed the leaching of trace heavy metals to water (antimony up to 2.41 µg/L and copper up to 4.68 µg/L). Liquid chromatography-mass spectrometry analysis identified polar organic species related to plastic additives and contaminants such as polyamide-66 monomers and oligomers.

Predicting progression to treatment using the Fagerström score in a free NHS smoking cessation programme.

A free, national smoking cessation service for adults based on behavioural and pharmaceutical support in Wales, UK. To establish whether the Fagerström score at the assessment session could be used to predict subsequent treatment attendance. Non-attendance affects the individual's health and the efficiency of the service. Anonymised data from 39 967 Stop Smoking Wales assessment session attendees were assessed using logistic regression. The outcome variable was subsequent attendance/non-attendance for at least one treatment session. Fagerström scores were grouped into 'very low' (0-2), 'low' (3-4), 'medium' (5) and 'high' (6-10). People with medium (OR 1.15, 95%CI 1.08-1.24) or low Fagerström scores (OR 1.07, 95%CI 1.00-1.14) were more likely to attend treatment sessions than people with very low (OR 1.03, 95%CI 0.94-1.12) or high (baseline) Fagerström scores. The final model comprised nine other statistically significant covariates: current age, sex, residential deprivation level, number of previous quit attempts, type of appointment (group or one-to-one), time of appointment, appointment season, time spent waiting for an appointment and distance from home to the clinic. The Fagerström score at the assessment session could be used to identify smokers at an increased risk of not attending subsequent treatment. Further research is required to evaluate the impact of targeting those with the highest and lowest Fagerström scores at the assessment session upon treatment attendance. .

Evaluation of neodymium isotope analysis of human dental enamel as a provenance indicator using 1013â€¯Ω amplifiers (TIMS).

Human provenance studies employing isotopic analysis have become an essential tool in forensic and archaeological sciences, with multi-isotope approaches providing more specific location estimates compared to single isotope studies. This study reports on the human provenancing capability of neodymium isotopes (143Nd/144Nd), a relatively conservative tracer in the environment. Neodymium isotope ratios have only recently been determined on human remains due to low concentrations in human dental enamel (ppb range), requiring thermal ionisation mass spectrometry (TIMS) using 1013â€¯Ω resistors. Dental elements (third molars) from 20 individuals born and raised in the Netherlands were analysed for Nd concentration (n = 12) and Nd isotope ratios (n = 15). The geological control on Nd isotope composition was examined using coupled Nd-Sr isotope analysis of the same third molar. Teeth from different geological environments were also analysed (Caribbean, Columbian, and Icelandic, n = 5). Neodymium elemental concentrations in dental elements ranged between 0.1 and 7.9 ppb (median 0.5 ppb). The Dutch 143Nd/144Nd ratios of the provinces of Limburg and Friesland were between 0.5118 and 0.5121, with Dutch 87Sr/86Sr ratios in agreement with the previously established local range (0.708-0.710). The current findings were compared to previously published results on Nd concentration and composition from Dutch individuals. The concentration of Nd and 143Nd/144Nd ratios were weakly correlated (R2 = 0.47, n = 17) in Dutch human dental enamel. The majority (n = 25, 83.3%) of individuals had Nd and Sr isotope values isotopically indistinguishable from the geological environment in which their third molars formed and mineralised. However, the Nd isotope ratios of the Icelandic individual and several Dutch individuals (n = 4) suggested that Nd in enamel is not solely influenced by geological environment. In order for neodymium isotopes to be quantitatively applied in forensic and archaeological settings further analyses of individuals from various geographical regions with well-defined dietary Nd isotope data are required.

Seeking, accepting and declining help for emotional distress in cancer: A systematic review and thematic synthesis of qualitative evidence.

Many individuals affected by cancer who experience emotional distress report not wanting help. This review aims to understand why individuals affected by cancer seek, accept or decline help for emotional distress and what influences these actions. A systematic review and thematic synthesis of the qualitative literature was conducted. Using pre-defined search terms, four electronic databases were searched from January 2000 to May 2016. Pre-determined inclusion and exclusion criteria were then applied. Identified papers were quality appraised. In total, 32 papers were included in the synthesis. Four themes emerged from data synthesis: attaining normality-the normality paradox; being emotionally literate; perceptions of help; needs-support gap. Attaining normality is ideographic, context dependent and temporally situated; some individuals maintain normality by not seeking/declining help whereas others seek/accept help to achieve a new normality. Thus, attaining normality paradoxically functions to explain both why individuals sought/accepted help or did not seek/declined help. Data indicate that a context dependent, systems thinking approach is merited to enhance psychosocial care. In particular, clinicians must actively explore the personal context of an individual's distress to ensure that help desired and help offered are mutually understood. Further research must address the limitations of the current evidence base to advance theoretical understanding.

Optimising molecular diagnostic capacity for effective control of tuberculosis in high-burden settings.

The World Health Organization's 2035 vision is to reduce tuberculosis (TB) associated mortality by 95%. While low-burden, well-equipped industrialised economies can expect to see this goal achieved, it is challenging in the low- and middle-income countries that bear the highest burden of TB. Inadequate diagnosis leads to inappropriate treatment and poor clinical outcomes. The roll-out of the Xpert(®) MTB/RIF assay has demonstrated that molecular diagnostics can produce rapid diagnosis and treatment initiation. Strong molecular services are still limited to regional or national centres. The delay in implementation is due partly to resources, and partly to the suggestion that such techniques are too challenging for widespread implementation. We have successfully implemented a molecular tool for rapid monitoring of patient treatment response to anti-tuberculosis treatment in three high TB burden countries in Africa. We discuss here the challenges facing TB diagnosis and treatment monitoring, and draw from our experience in establishing molecular treatment monitoring platforms to provide practical insights into successful optimisation of molecular diagnostic capacity in resource-constrained, high TB burden settings. We recommend a holistic health system-wide approach for molecular diagnostic capacity development, addressing human resource training, institutional capacity development, streamlined procurement systems, and engagement with the public, policy makers and implementers of TB control programmes.

Effects of exercise intensity on clot microstructure and mechanical properties in healthy individuals.

BACKGROUND: Exercise is well established to lead to exercise-induced hypercoagulability, as demonstrated by kinetic coagulation markers. It remains unclear as to whether exercise-induces changes lead in clot development and increased polymerisation. Fractal dimension (df) has been shown to act as a marker of clot microstructure and mechanical properties, and may provide a more meaningful method of determining the relationship between exercise-induced hypercoagulability and potential clot development. METHODS: df was measured in 24 healthy individuals prior to, after 5min of submaximal exercise, following maximal exercise, 45min of passive recovery and following 60min of recovery. Results were compared with conventional markers of coagulation, fibrinolysis and SEM images. RESULTS: Significantly increased df was observed following exercise, returning to resting values following 60min of recovery. The relationship between df and mature clot microstructure was confirmed by SEM: higher df was associated with dense clots formed of smaller fibrin fibres immediately following exercise compared to at rest. Conventional markers of coagulation confirmed findings of previous studies. CONCLUSION: This study demonstrates that df is a sensitive technique which quantifies the structure and properties of blood clots following exercise. In healthy individuals, the haemostatic balance between coagulation and fibrinolysis is maintained in equilibrium following exercise. In individuals with underlying vascular damage who participate in exercise, this equilibrium may be displaced and lead to enhanced clot formation and a prothrombotic state. df may therefore have the potential to not only quantify hypercoagulability, but may also be useful in screening these individuals.

Hot super-Earths stripped by their host stars.

Simulations predict that hot super-Earth sized exoplanets can have their envelopes stripped by photoevaporation, which would present itself as a lack of these exoplanets. However, this absence in the exoplanet population has escaped a firm detection. Here we demonstrate, using asteroseismology on a sample of exoplanets and exoplanet candidates observed during the Kepler mission that, while there is an abundance of super-Earth sized exoplanets with low incident fluxes, none are found with high incident fluxes. We do not find any exoplanets with radii between 2.2 and 3.8 Earth radii with incident flux above 650 times the incident flux on Earth. This gap in the population of exoplanets is explained by evaporation of volatile elements and thus supports the predictions. The confirmation of a hot-super-Earth desert caused by evaporation will add an important constraint on simulations of planetary systems, since they must be able to reproduce the dearth of close-in super-Earths.

Methods for selecting regimen duration to prevent relapse in drug-susceptible and drug-resistant TB.

Predicting the required duration of treatment necessary to yield an acceptable risk of recurrence is a key question facing Phase III trials in both drug-susceptible (DS) and multidrug-resistant tuberculosis (MDR-TB). Data on treatment duration from animal models are increasingly a focus of such studies, but they have not been calibrated against human clinical trials and are lacking in MDR-TB. Empirical meta-regression models based on clinical trials in DS-TB suggest that early bacteriological results and treatment duration may have value in predicting relapse, and have been prospectively validated against the results of three large randomised controlled trials in DS-TB. While few trials have been conducted in MDR-TB to date, and observational cohort data should be interpreted carefully due to bias and confounding, these models also appeared to perform well in two recent cohort studies of MDR-TB. Applying these insights in practice may require innovations in clinical trial design, such as more extensive selection, adaptation and use of multiple durations during Phases II and III. While several studies have identified important individual level prognostic variables that could improve the accuracy of relapse prediction, attempts to stratify treatment duration for individual patients based on these factors have so far met with limited success.

Vitamin D deficiency in Malawian adults with pulmonary tuberculosis: risk factors and treatment outcomes.

SETTING: Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART). It is unclear whether vitamin D deficiency influences response to anti-tuberculosis treatment. OBJECTIVES: To describe risk factors for baseline vitamin D deficiency in Malawian adults with pulmonary TB, assess the relationship between serum 25-hydroxy vitamin D (25[OH]D) concentration and treatment response, and evaluate whether the administration of anti-tuberculosis drugs and ART is deleterious to vitamin D status during treatment. DESIGN: A prospective longitudinal cohort study. RESULTS: The median baseline 25(OH)D concentration of the 169 patients (58% human immunodeficiency virus [HIV] infected) recruited was 57 nmol/l; 47 (28%) had vitamin D deficiency (<50 nmol/l). Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019). No relationship between vitamin D status and anti-tuberculosis treatment response was found. 25(OH)D concentrations increased during anti-tuberculosis treatment, irrespective of HIV status or use of ART. CONCLUSIONS: Vitamin D deficiency is common among TB patients in Malawi, but this does not influence treatment response. Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.

Adaptive clinical trials in tuberculosis: applications, challenges and solutions.

Drug development for tuberculosis (TB) faces numerous practical obstacles, including the need for combination treatment with at least three drugs, reliance on possibly unrepresentative animal models which may not reproduce key features of human disease and the lack of a well-validated surrogate endpoint for stable cure. Pivotal Phase III trials are large, lengthy and expensive, and the funding and capacity to conduct them are limited worldwide. More rational methods for the selection of priority regimens for Phase III are urgently needed to avoid costly late-stage failures. We examine the suitability of adaptive clinical trial designs for drug development in TB, focusing on designs for Phase IIB and III trials, where we believe the biggest gains in efficiency can be made. Key areas that may be addressed by such designs are improvements in the selection of doses and combinations of drugs in early clinical development and in maximising the power of confirmatory trials in multidrug-resistant TB, where patient numbers and complexity pose practical limitations. We encourage trialists and regulators in this area to consider the advantages that may be offered by these designs and their potential to more effectively and rapidly identify better treatment regimens for TB patients worldwide.

Pharmacokinetics of anti-TB drugs in Malawian children: reconsidering the role of ethambutol.

BACKGROUND: Current guidelines for dosing of anti-TB drugs in children advocate higher doses for rifampicin and isoniazid despite limited availability of paediatric data on the pharmacokinetics of these drugs, especially from Africa, where the burden of childhood disease remains high. METHODS: Thirty children aged 6 months to 15 years underwent intensive pharmacokinetic sampling for first-line anti-TB drugs at Queen Elizabeth Central Hospital, Blantyre, Malawi. Rifampicin, isoniazid, pyrazinamide and ethambutol were dosed at 10, 5, 25 and 20 mg/kg, respectively. Plasma drug concentrations were determined using sensitive, validated bioanalytical methods and summary pharmacokinetic parameters were estimated using non-compartmental analysis. RESULTS: The median (IQR) Cmax was 2.90 (2.08-3.43), 3.37 (2.55-4.59), 34.60 (32.30-40.90) and 1.20 (0.85-1.68) mg/L while the median (IQR) AUC0-∞ was 16.92 (11.10-22.74), 11.48 (7.35-18.93), 333.50 (279.50-487.2) and 8.65 (5.96-11.47) mg·h/L for rifampicin, isoniazid, pyrazinamide and ethambutol, respectively. For all drugs, pharmacokinetic parameters relating to drug absorption and exposure were lower than those published for adults, though similar to existing paediatric data from sub-Saharan Africa. Weight and/or dose predicted at least one measure of exposure for all drugs. Age-related decreases in CL/F for rifampicin and pyrazinamide and a biphasic elimination pattern of isoniazid were observed. Predicted AUC0 -∞ for rifampicin dosed at 15 mg/kg was comparable to that of adults while the dose required to achieve ethambutol exposure similar to that in adults was 55 mg/kg or higher. CONCLUSIONS: These data support recently revised WHO recommendations for dosing of anti-TB drugs in children, but dosing of ethambutol in children also appears inadequate by comparison with adult pharmacokinetic data.

Factors controlling the oral bioaccessibility of anthropogenic Pb in polluted soils.

In human risk assessment, ingestion of soil is considered a major route of toxic Pb exposure. A large body of research has focussed on the measurement of the 'total' Pb contents in sediment, soil and dust as a measure for the exposure to lead. We report that Pb bioaccessibility (i.e. the maximum bioavailability), determined with an in vitro test, does not necessarily depend on the total Pb content. In contrast, the Pb bioaccessibility is initially controlled by the chemical form and particle size of the Pb source, which in turn determine its solubility. Furthermore, when anthropogenic Pb resides within the soil, it may form new, more stable, minerals and/or binds to organic matter, clay, reactive iron or other reactive phases, changing its bioaccessibility. The bioaccessible Pb fraction of 28 soils, polluted with various Pb sources (including residues of Pb bullets and pellets, car battery Pb, city waste and diffuse Pb), was determined with an in vitro-test and varied from 0.5% to 79.0% of total Pb. The highest Pb bioaccessibility (60.7% to 79.0%) was measured in soils polluted with residues of Pb bullets and pellets (shooting range), while the lowest Pb bioaccessibility (0.5%-8.3%) was measured in soils polluted with city waste (including remnants of Pb glazed potsherds and rooftiles, Pb based paint flakes, and Pb sheets). Bioaccessibility of Pb was correlated with pH, organic matter and reactive Fe. These results indicate that soil characteristics play an important role in the oral bioaccessibility of lead in polluted soils. Instead of basing human risk assessment solely on total Pb contents we propose to incorporate in vitro bioaccessibility tests, taking factors such as soil pH, organic matter content and reactive iron content into account. This approach will result in a better insight into the actual risks of Pb polluted soils to children.

Reconstruction of historical atmospheric Pb using Dutch urban lake sediments: a Pb isotope study.

Lake sediments provide a record of atmospheric Pb deposition and changes in Pb isotope composition. To our knowledge, such an approach has not previously been performed in The Netherlands or linked to national air monitoring data. Results are presented for Pb content and isotope composition of (137)Cs dated lake sediments from 2 Dutch urban lakes. Between 1942 and 2002A.D. anthropogenic atmospheric Pb deposition rates in the two lakes varied from 12±2 to 69±16µgcm(-2)year(-1). The rise and fall of leaded gasoline is clearly reflected in the reconstructed atmospheric Pb deposition rates. After the ban on leaded gasoline, late 1970s/early 1980s, atmospheric Pb deposition rates decreased rapidly in the two urban lakes and the relative contributions of other anthropogenic Pb sources - incinerator ash (industrial Pb) and coal/galena - increased sharply. Atmospheric Pb deposition rates inferred from the lake record a clear relationship with nearby measured annual mean air Pb concentrations. Based on this relationship it was estimated that air Pb concentrations between 1942 and 2002A.D. varied between 5 and 293ng/m(3).

Measurement of small ion beams by thermal ionisation mass spectrometry using new 10(13) Ohm resistors.

We tested 5 newly manufactured - prototype - 10(13)Ohm resistors in the feedback loop of Faraday cup amplifiers to measure small ion beams by Thermal Ionisation Mass Spectrometry (TIMS). The high Ohmic resistors installed in the TRITON Plus at the VU University Amsterdam theoretically have 10 times lower noise levels relative to the default 10(11)Ohm resistors. To investigate the precision and accuracy of analyses using these new amplifiers we measured Sr and Nd isotopes of reference standards at a range of ion currents (3.2×10(-16) to 1×10(-12) A, corresponding to intensities of 32 µV to 100 mV on a default 10(11)Ohm amplifier) and on small amounts of material (100 and 10 pg). Internal precision and external reproducibility for Sr and Nd isotope ratios are both better when collected on 10(13) compared 10(12)Ohm resistors and to the default 10(11)Ohm resistors. At an (87)Sr ion current of 3×10(-14) A (3 mV on a 10(11)Ohm amplifier) the internal precision (2 SE) of (87)Sr/(86)Sr is 5 times better for 10(13)Ohm resistors compared to 10(11)Ohm resistors. The external reproducibility (2 SD) at this beam intensity is 9 times better. Multiple 100 and 10 pg Sr standards, ran to exhaustion, yielded low (87)Sr/(86)Sr compared to the long term average (e.g. 10 pg average=0.710083±164 (n=11) instead of 0.710244±12, n=73). The average off-set for 10 pg standards can be explained by a loading blank contribution of 1.3 pg. In contrast, Nd data on 100 pg and 10 pg samples are accurate suggesting that Nd loading blanks do not compromise the data. The external reproducibility of (143)Nd/(144)Nd on 100 pg samples is 125 ppm and 3.3‰ on 10 pg samples (2 RSD=relative standard deviation, n=10). Thus, variability in Nd and Sr isotope ratios in the 4th decimal place, e.g. (143)Nd/(144)Nd 0.5110-0.5119 or (87)Sr/(86)Sr 0.7100-0.7109, can be resolved in 10 to 100 pg samples provided that the procedural blanks and chemical separation are optimal. For measurements in the beam intensity range usually covered by ion counting (<3 mV or 2×10(5) cps) we obtain a (143)Nd/(144)Nd internal precision (2 SE) of 480 ppm for a (143)Nd intensity of 6.25×10(4) cps (1 mV) and 1% at an intensity of 2×10(3) cps (32 µV on a 10(11)Ohm amplifier). We find that at intensities higher than 2×10(4) cps the precision using the 10(13)Ohm resistors is better than for ion counting owing to instability and non-linearity behaviour of the ion counting system. Our results indicate that between 2×10(4) cps and an ion current of 2×10(-13) A (20 mV on a 10(11)Ohm amplifier) it is beneficial to use the high gain amplifiers instead of (multi) ion counting or Faraday cups equipped with the standard 10(11)Ohm resistors. This finding suggests that the newly developed high gain resistors could potentially be valuable in applications that currently use (multiple) ion counting to measure small ion beams (e.g. U-series, Re-Os, Pu, Pb). In addition to improved precision, the use of Faraday cups equipped with high resistance amplifiers is more practical in terms of the required calibration procedure and in the flexibility in the collector set-up compared to using multiple ion counting arrays.

The lead (Pb) isotope signature, behaviour and fate of traffic-related lead pollution in roadside soils in The Netherlands.

In this study the origin, behaviour and fate of anthropogenic Pb in sandy roadside soils were assessed by measuring soil characteristics, Pb isotope composition and content. In 1991 and 2003 samples were taken at different depth intervals at approximately 8 and 75 m from two highways in The Netherlands. The Pb isotope composition of the litter layer ((206)Pb/(207)Pb=1.12-1.14) differs from the deeper soil samples ((206)Pb/(207)Pb=1.20-1.21). Based on a mixing model it is concluded that the samples contain two Pb sources: natural Pb and anthropogenic Pb, the latter mainly derived from gasoline. (206)Pb/(207)Pb ratios demonstrate that the roadside soils were polluted to a depth of ~15 cm. Within this depth interval, anthropogenic Pb content is associated with organic matter. Although Pb pollution only reached a depth of ~15 cm, this does not mean that the topsoils retain all anthropogenic Pb. Due to the low pH and negligible binding capacity of soils at depths >15 cm, anthropogenic Pb migrated towards groundwater after reaching depths of >15 cm. The Pb isotope composition of the groundwater ((206)Pb/(207)Pb=1.135-1.185) establishes that groundwater is polluted with anthropogenic Pb. The contribution of anthropogenic Pb to the groundwater varies between ~30 and 100%. Based on the difference in soil Pb content and Pb isotope compositions over a period of 12 years, downward Pb migration is calculated to vary from 72 ± 95 to 324 ± 279 mg m(-2)y(-1). Assuming that the downward Pb flux is constant over time, it is calculated that 35-90% of the atmospherically delivered Pb has migrated to the groundwater.

Bridging the gap in the fight against tuberculosis.

Identifying the most effective new drugs for tuberculosis will depend on developing systems for preclinical testing that better reflect conditions in the diseased host and the characteristics of persistent M tuberculosis. Integrating information from these diverse new technologies using a model-based approach to antituberculosis drug development could facilitate more effective use of this information in transitioning novel compounds successfully to the clinical phase.

Opinion: the pharmacometrics of infectious disease.

The application of pharmacometric principles to the treatment of infectious diseases must address important biological issues across the diversity of pathogenic organisms. Recent applications of pharmacometric tools in this therapeutic area have had important translational impact not only in drug development but on real-world clinical practice. The fruitful fusion of preclinical and population methodologies promises increasingly personalized and mechanistic approaches.CPT: Pharmacometrics & Systems Pharmacology (2013) 2, e70; doi:10.1038/psp.2013.46; published online 28 August 2013.

Oral cavity squamous cell carcinoma survival by biopsy type: a cancer registry study.

BACKGROUND: Biopsy of a suspected oral squamous cell carcinoma (SCC) is important for diagnosis. Concerns have been raised about the potential for tumour spread by incisional biopsy techniques. This study aimed to investigate the five-year survival and recurrence of oral SCC after incisional and excisional biopsy in total population data available from the Western Australian Cancer Registry (WACR). METHODS: Total population data from the WACR, comprising all primary oral SCC cases diagnosed between 1990 and 1999, were examined. Information extracted included date of birth, gender, biopsy date, biopsy type, disease stage (TNM classification), disease site, date of recurrence and date of death. Records were excluded if the diagnosis was fine needle aspiration based, was not that of oral SCC and if a history was noted of another malignant neoplasm. Incisional and excisional biopsy cases were compared for five-year survival, adjusting for disease stage. RESULTS: No association was found between biopsy type and five-year survival or recurrence amongst individuals with Stage I or II disease. CONCLUSIONS: In this study, biopsy type was not associated with survival of oral SCC patients with Stage I or II disease, adding to the evidence that incisional biopsy of oral SCC can be a safe procedure.

Pharmacokinetics and pharmacodynamics in the development of anti-tuberculosis drugs.

Optimization of dosing strategies and companion drugs prior to Phase III trials is currently a critical obstacle in the development of new anti-tuberculosis drugs. Pharmacokinetic-pharmacodynamic (PK-PD) methods have assumed an important role in improving the efficiency of this process across the pharmaceutical industry and in other areas of anti-infective therapy. Information gained using PK-PD methods from the earliest in vitro assessments right up to the end of Phase II development can underpin proof-of-concept and ensure that agents are fully pharmacologically optimized. Despite our limited understanding of the biology of bacillary elimination in vivo, such an approach has already provided key insights into these mechanisms and helped to identify the role of different drugs in therapy and assess their potential for progression to pivotal trials. While isoniazid appears historically to have been effectively exploited, human studies suggest that it does not play a key role in the sterilizing phase of treatment. Re-evaluation of the PK-PD of rifamycins by contrast suggests that there may be considerable scope for improving their activity by intensifying current dosing strategies. Various PK-PD analyses of the fluoroquinolone series demonstrate remarkable agreement concerning the ranking of their sterilizing activity, results which appear to be confirmed in recent human phase II studies. The pharmacological characteristics of completely new classes of drugs now entering clinical development suggest that experience with existing drugs, particularly EBA studies, should not prejudice evaluation of their pharmacodynamic activity which may differ qualitatively from that of many current agents. In conclusion, PK-PD analysis has a vital role to play in the rational development of new anti-tuberculosis drugs and combination regimens.