Cost-effectiveness considerations in finding appropriate chemotherapy treatments for bacterial diseases in developing countries: The case of tuberculosis.

Infectious bacterial diseases in developing countries represent a major health threat. Living conditions and environment decrease health status such that those in developing countries are left vulnerable to many diseases that are seldom seen in industrialised countries. Many treatments for these diseases have proven very effective, making infectious bacterial disease one of the best targets for high yield, low cost health interventions. Antibiotics remain the primary approach in treating infectious bacterial disease, yet mismanagement in their use has led to unnecessary resistance making many major diseases difficult to treat. Additionally, poor antibiotic choices for treating diseases have further contributed to unnecessary resistance. The appropriate choice for treating diseases is not always made and many diseases continue to be treated with inappropriate drugs or combinations of drugs. Many treatments are chosen on the basis of their easy availability or their small cost, when in fact other treatments could be obtained that have a more substantial impact on decreasing the incidence of a given disease. This is especially true in the treatment of tuberculosis. Tuberculosis, once thought to have been almost eradicated, has been revived by the growth of HTV. TB still claims a substantial proportion of human lives and will be responsible for 30 million deaths in this decade alone. Of particular relevance is the rising incidence of drug resistant cases of TB, which is primarily due to inappropriate antibiotic use. Although some past research has acknowledged the influence of resistance on the cost of TB treatment in developing countries, few studies have thoroughly analysed this relationship. This thesis presents a comprehensive study of the impact of drug resistance on the cost of TB treatment within the context of a cost-effectiveness analysis comparing short-course chemotherapy and the standard drug regimen in Ethiopia. In addition, the impact of HIV on TB treatment is analysed together with other factors, such as case holding, in order to assess their respective influence on the cost of treatment. Criteria for better management of tuberculosis control efforts in order to eradicate this disease and control resistance are subsequently explored. Finally, a discussion of the broader applicability of the conclusions of these studies to many developing countries is presented

Childhood outcomes in children with and without cardiac echogenic foci: An electronic birth cohort study in Wales, UK

There is uncertainty about outcomes associated with cardiac echogenic foci (CEF) seen at the midtrimester ultrasound scan because of limited population-based follow-up data. This can lead to unnecessary invasive testing and significant parental anxiety. We analysed data from a cohort study, The Welsh Study of Mothers and Babies, to examine whether children with CEF had more adverse outcomes during childhood compared with children without CEF. Children born between 1 January 2009 and 31 December 2011 were followed until 31 January 2018, migration out of Wales, or death. The primary outcome was cardiac hospital admissions, defined a priori by an expert steering group. Secondary outcomes included congenital cardiac anomalies, and hospital admissions for other causes. There was no evidence of an association between isolated CEF and cardiac hospital admissions (hazard ratio 0.87, 95% confidence interval [CI] 0.33–2.25, p value 0.768), or with congenital cardiac anomalies. There was a small increased risk of a respiratory admission with isolated CEF (hazard ratio 1.27, 95% CI 1.04–1.54, p value 0.020). Further research is needed on features of CEF, such as location or number, to fully understand the clinical significance of these findings

An Assessment of the Feasibility and Acceptability of a Friendship-Based Social Network Recruitment Strategy to Screen At-Risk African American and Hispanic/Latina Young Women for HIV Infection

To examine the feasibility and acceptability of a friendship-based network recruitment strategy for identifying undiagnosed human immunodeficiency virus (HIV) infection within young women’s same-sex friendship networks and to determine factors that facilitated and hindered index recruiters (IRs) in recruiting female friendship network members (FNMs) as well as factors that facilitated and hindered FNMs in undergoing HIV screening

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Biomass burning drives atmospheric nutrient redistribution within forested peatlands in Borneo

Biomass burning plays a critical role not only in atmospheric emissions, but also in the deposition and redistribution of biologically important nutrients within tropical landscapes. We quantified the influence of fire on biogeochemical fluxes of nitrogen (N), phosphorus (P), and sulfur (S) in a 12 ha forested peatland in West Kalimantan, Indonesia. Total (inorganic + organic) N, ${{{\rm{NO}}}_{3}}^{-}$ –N, ${{{\rm{NH}}}_{4}}^{+}$ –N, total P, ${{{\rm{PO}}}_{4}}^{3-}$ –P, and ${{{\rm{SO}}}_{4}}^{2-}$ –S fluxes were measured in throughfall and bulk rainfall weekly from July 2013 to September 2014. To identify fire events, we used concentrations of particulate matter (PM _10 ) and MODIS Active Fire Product counts within 20 and 100 km radius buffers surrounding the site. Dominant sources of throughfall nutrient deposition were explored using cluster and back-trajectory analysis. Our findings show that this Bornean peatland receives some of the highest P (7.9 kg ${{{\rm{PO}}}_{4}}^{3-}$ –P ha ^−1 yr ^−1 ) and S (42 kg ${{{\rm{SO}}}_{4}}^{2-}$ –S ha ^−1 yr ^−1 ) deposition reported globally, and that N deposition (8.7 kg inorganic N ha ^−1 yr ^−1 ) exceeds critical load limits suggested for tropical forests. Six major dry periods and associated fire events occurred during the study. Seventy-eight percent of fires within 20 km and 40% within 100 km of the site were detected within oil palm plantation leases (industrial agriculture) on peatlands. These fires had a disproportionate impact on below-canopy nutrient fluxes. Post-fire throughfall events contributed >30% of the total inorganic N ( ${{{\rm{NO}}}_{3}}^{-}$ –N + ${{{\rm{NH}}}_{4}}^{+}$ –N) and ${{{\rm{PO}}}_{4}}^{3-}$ –P flux to peatland soils during the study period. Our results indicate that biomass burning associated with agricultural peat fires is a major source of N, P, and S in throughfall and could rival industrial pollution as an input to these systems during major fire years. Given the sheer magnitude of fluxes reported here, fire-related redistribution of nutrients may have significant fertilizing or acidifying effects on a diversity of nutrient-limited ecosystems

An assessment of the feasibility and acceptability of a friendship-based social network recruitment strategy to screen at-risk African American and Hispanic/Latina young women for HIV infection.

OBJECTIVES To examine the feasibility and acceptability of a friendship-based network recruitment strategy for identifying undiagnosed human immunodeficiency virus (HIV) infection within young women's same-sex friendship networks and to determine factors that facilitated and hindered index recruiters (IRs) in recruiting female friendship network members (FNMs) as well as factors that facilitated and hindered FNMs in undergoing HIV screening. DESIGN A cross-sectional study design that incorporated dual incentives for IRs and their female FNMs. SETTING The IRs were recruited through 3 Adolescent Trials Network for HIV/AIDS Interventions sites within their Adolescent Medicine Trials Units. Data were collected from January 1, 2009, through June 30, 2010. PARTICIPANTS The IRs self-identifying as HIV positive, negative, or status unknown were enrolled to recruit FNMs to undergo HIV screening. MAIN OUTCOME MEASURES Self-reports of HIV risk and facilitators and barriers to network recruitment and HIV screening were assessed using an audio-computer-assisted self-interview. Participants were identified as HIV negative or positive on the basis of an OraQuick HIV test with confirmatory enzyme-linked immunosorbent assay and/or Western blot tests. RESULTS Nearly all (156 [98.1%]) eligible IRs agreed to participate and most (78.4%) recruited 1 or more FNMs. Of the 381 FNMs, most (342 [89.8%]) agreed to HIV screening. Although a high acceptance of HIV screening was achieved, the HIV prevalence was low (0.26%). CONCLUSION Our findings provide compelling evidence to suggest that use of a female friendship network approach is a feasible and acceptable means for engaging at-risk young women in HIV screening, as shown by their high rates of agreement to undergo HIV screening