Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa

Background Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. Methods An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. Findings In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6$50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement. Conclusion The cost thresholds identified suggest that there is clear scope for adherence monitoringbased interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit

The application of warfare ecology to belligerent occupations

Insofar as warfare ecology aims to examine all war-related conditions, belligerent occupations are a necessary stage in its broad taxonomy. Under international law, belligerent occupations are covered by a distinctive subset of jus in bello (humanitarian law), which is imprecise regarding ecological changes. This chapter examines the potential role of warfare ecology in studying belligerent occupations, highlighting the multiple, often indirect, means by which such occupations shape ecological processes. Particular attention is paid to the Israeli occupation of Palestinian territory, due to its protracted duration, although also discussed are environmental effects associated with the US and UK occupation of Iraq. The onus on the occupying power, under international humanitarian law, to protect the conditions of life for civilians can plausibly be applied to the environmental resources of the resident population. It is argued that warfare ecology can make a significant contribution both to assessing the effects of occupations and, through the generation of policy advice, to promote conflict outcomes more sensitive towards ecological processes

Trwałość agregatów glebowych na terenach użytkowanych rolniczo w dystrykcie Hyderabad, Pakistan

Arid areas are particularly susceptible to soil erosion due to long dry periods and sudden heavy downpours. This study investigates the aggregate size distribution and aggregate stability of twelve tilled fallow areas of Hyderabad district, Sindh, Pakistan. This study determined aggregate size distribution by dry sieving to evaluate the seedbed condition and aggregate stability using wet sieving to assess the susceptibility of tilled fallow areas to soil erosion. The aggregate size distribution of the soils of the selected areas was highly variable. Gulistan-e-Sarmast had the largest number of clods (51.0%) followed by Kohsar (49.0%), Latifabad # 10 (41.10%) and Daman-e-Kohsar (39.0%). Fazal Sun City, the left side of the Indus River, the Village Nooral Detha and the left side of the Abdullah Sports city had a greater number of large (>8.0 mm) and small aggregates (<0.5 mm). The optimum aggregate size distribution was found in the left side of the channel, which had the largest number of aggregates (50.50%) in the 0.5–8.0 mm sieve size range. Maximum aggregate stability (AS) was found in Gulistan- e-Sarmast (46%), Kohsar (42%) and Latifabad # 10 (34%), while all other soils had minimum aggregate stability (<14%). The minimum aggregate stabilities demonstrate that the tilled fallow areas of Hyderabad district are highly susceptible to erosion. Therefore, the present study suggests investigating potential ways to enhance the aggregate stabilities of soils.Obszary o klimacie zwrotnikowym suchym są szczególnie podatne na erozję gleby z powodu długich okresów suszy i nagłych ulewnych opadów deszczu. W pracy przedstawiono wyniki badań rozkładu wielkości agregatów glebowych i ich trwałości w dwunastu uprawianych gruntach dystryktu Hyderabad w Sindh w Pakistanie. Rozkład wielkości agregatów oznaczano poprzez przesiewanie suchej gleby, a trwałość agregatów określano metodą przesiewania na mokro. Wielkości te charakteryzują podatność gleb uprawnych na erozję. Rozkład granulometryczny gleb na badanym obszarze był silnie zróżnicowany. Największą liczbę agregatów (51,0%) zawierała gleba w Gulistan-e-Sarmast, mniejszą – gleba w Kohsar (49,0%), Latifabad (41,1%) i Daman-e-Kohsar (39,0%). Gleby na terenie miasta Fazal Sun na lewym brzegu Indusu, gleby we wsi Nooral Detha i mieście Abdullah Sports charakteryzowały się znaczną liczbą dużych (>8 mm) i małych (<0,5 mm) agregatów. Optymalny rozkład wielkości agregatów glebowych stwierdzono na lewym brzegu kanału, gdzie gleba zawierała najwięcej (50,5%) agregatów w przedziale wielkości 0,5–8,0 mm. Maksymalną trwałość agregatów wykazywały gleby w Gulistan-e-Sarmast (46%), Kohsar (42%) i Latifabad (34%), trwałość agregatów pozostałych gleb była minimalna (<14%). Stwierdzona minimalna trwałość agregatów świadczy, że gleby użytkowane rolniczo w dystrykcie Hyderabad są silnie podatne na erozję. Wyniki przedstawionych badań sugerują potrzebę poszukiwania sposobów na zwiększenie trwałości agregatów glebowych

A Review of Breast Cancer Surgeries in a Sub-urban Nigerian Tertiary Hospital and the Limitations of Breast-Conserving Surgery

Background: The surgical management of breast cancer involves either modified radical mastectomy or a conservative approach. Breast-conserving surgery is the preferred surgical treatment for early breast cancer in developed countries, while mastectomy is still more favoured by most centres in developing countries. Objectives: To report some quality data on breast cancer surgeries from a sub-urban tertiary hospital in Nigeria. Design: Retrospective analysis Methods: We retrospectively reviewed all breast cancer surgeries performed between January 2018 and December 2022 at the Irrua Specialist Teaching Hospital. Results: A total of 105 female patients underwent breast cancer surgery. Their ages ranged between 27 and 85 years, with a mean of 48.8 years (SD = 12.2). The mean duration of symptoms before presentation was 12.3 ± 17.8 months (1-120 months), with 15.2% presenting with stage I and II disease and 84.7% presenting with stage III and IV disease. Invasive carcinoma NST was the most common histological type in 78 (74.3%) patients. The cancers were predominantly high grade (42.3%) and triple negative (41.5%). Only 9.5% of the patients had breast-conserving surgery, the others had mastectomy. Sixty-three patients (60%) received neoadjuvant chemotherapy while only 25.7% of patients had documented evidence of the completion of adjuvant radiotherapy. Conclusion: The rate of breast-conserving surgery in this study was extremely low. This could be attributed to the advanced stage at presentation, predominance of aggressive tumours, limited access to radiation therapy, status of the medical system, and patient preferences

Farm Tractors in Nasirabad Balochistan

Abstract: Thi