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Network averages are important to consider when looking at the overall performance of the network purchase suhagra 100 mg online, but disguise variation within the network by round of laboratory proficiency testing order 100mg suhagra visa. Table 12 shows the variation within the network for the 13th round of proficiency testing; however, in previous rounds, at least one or two laboratories per round showed suboptimal performance. Because results are determined judicially, strains with less than 80% concordance within the network are excluded from standard evaluation; however, these strains have been examined in subsequent studies to determine the reason for borderline results. The number of strains excluded in recent rounds were 9 (rounds 9 and 10), 7 (round 11), 12 (round 12) and 3 (round 13), representing approximately 7% (40/600) of the total strains tested. Table 11: Average performance of Supranational Reference Laboratory Network laboratories over five rounds of proficiency testing. The number of countries submitting survey protocols through national ethics committees has increased, as has attention to quality assurance of patient classification, laboratory results and data entry. The areas represented in this project are those with at least the minimum requirements to conduct drug resistance surveys. However, the project has generally not achieved its primary objective, which is to measure trends in drug resistance in high- burden countries. However, operational difficulties in the implementation of repeated surveys show that it may be time to re-evaluate the survey methods used, and to coordinate supplementary research to answer the epidemiological questions that routine drug resistance surveillance cannot. Current survey methods are based on smear-positive cases for operational reasons; that is, smear-positive cases are more likely to result in a positive culture required for drug-susceptibility testing. Current survey methods are based on patients notified in the public sector; they do not attempt to evaluate prevalent cases, chronic populations of patients or patients in the private sector. There are significant operational difficulties in designing such surveys within the context of routine programmes, and the resulting information may not warrant the expense required. Additional research may be useful to explore the prevalence of drug resistance in these three populations. Another limitation of current methodology has been the ability to determine true acquired resistance. Previous reports have suggested that resistance among previously treated cases may be a useful proxy for acquired resistance. Previously treated cases are a heterogeneous group that may also represent cases that were primarily infected with a resistant strain, failed therapy and acquired further resistance.

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Guam is supported by the Microbial Diseases Laboratory generic suhagra 100mg with amex, San Francisco buy discount suhagra 100mg on-line, California, United States. Information on methods used and quality assurance were not collected for this report. All data (in the form of annexed tables) were returned to the country for a final review before publication, and were then entered into a Microsoft Access database. Statistical analysis Drug-resistance data for new, previously treated and combined cases were analysed. Arithmetic means, medians and ranges were determined as summary statistics for new, previously treated and combined cases; for individual drugs; and for pertinent combinations. For geographical settings reporting more than a single data point since the third report, only the latest data point was used for the estimation of point proportion. Population- 31 weighted means from the last data point of all countries reporting to the project were calculated to reflect the mean proportion of resistance by region, based on countries within the region reporting data to the project. Global data using the last data point from all reporting countries For maps, means and global project coverage estimates, the last data point from all settings ever reporting to the project were included. Dynamics of resistance over time A proportion of drug resistance among new cases was analysed in survey settings among new and combined cases in settings conducting routine surveillance. Only countries and settings with three or more data points were included in this exercise. For settings that reported at least three data points, the trend was determined visually as ascending, descending, flat or indeterminate. The relative increase or decrease was expressed as a proportion, and statistical significance of trends was determined through a logistic regression. For Brazil, the Central African Republic, Kenya, Sierra Leone and Zimbabwe, the surveys covered most of the area of each country.