Comparing multidrug-resistant tuberculosis patient costs under molecular diagnostic algorithms in South Africa

SETTING: Ten primary health care facilities in Cape Town, South Africa, 2010–2013. OBJECTIVE: A comparison of costs incurred by patients in GenoType® MDRTBplus line-probe assay (LPA) and Xpert® MTB/RIF-based diagnostic algorithms from symptom onset until treatment initiation for multidrug-resistant tuberculosis (MDR-TB). METHODS: Eligible patients identified from laboratory and facility records were interviewed 3–6 months after treatment initiation and a cost questionnaire completed. Direct and indirect costs, individual and household income, loss of individual income and change in household income were recorded in local currency, adjusted to 2013 costs and converted to $US. RESULTS: Median number of visits to initiation of MDR-TB treatment was reduced from 20 to 7 (P < 0.001) and median costs fell from US$68.1 to US$38.3 (P = 0.004) in the Xpert group. From symptom onset to being interviewed, the proportion of unemployed increased from 39% to 73% in the LPA group (P < 0.001) and from 53% to 89% in the Xpert group (P < 0.001). Median household income decreased by 16% in the LPA group and by 13% in the Xpert group. CONCLUSION: The introduction of an Xpert-based algorithm brought relief by reducing the costs incurred by patients, but loss of employment and income persist. Patients require support to mitigate this impact

Comparing laboratory costs of smear/culture and Xpert(®) MTB/RIF-based tuberculosis diagnostic algorithms

SETTING: Cape Town, South Africa, where Xpert® MTB/RIF was introduced as a screening test for all presumptive tuberculosis (TB) cases. OBJECTIVE: To compare laboratory costs of smear/culture- and Xpert-based tuberculosis (TB) diagnostic algorithms in routine operational conditions. METHODS: Economic costing was undertaken from a laboratory perspective, using an ingredients-based costing approach. Cost allocation was based on reviews of standard operating procedures and laboratory records, timing of test procedures, measurement of laboratory areas and manager interviews. We analysed laboratory test data to assess overall costs and cost per pulmonary TB and multidrug-resistant TB (MDR-TB) case diagnosed. Costs were expressed as 2013 Consumer Price Index-adjusted values. RESULTS: Total TB diagnostic costs increased by 43%, from US$440 967 in the smear/culture-based algorithm (April–June 2011) to US$632 262 in the Xpert-based algorithm (April–June 2013). The cost per TB case diagnosed increased by 157%, from US$48.77 (n = 1601) to US$125.32 (n = 1281). The total cost per MDR-TB case diagnosed was similar, at US$190.14 and US$183.86, with 95 and 107 cases diagnosed in the respective algorithms. CONCLUSION: The introduction of the Xpert-based algorithm resulted in substantial cost increases. This was not matched by the expected increase in TB diagnostic efficacy, calling into question the sustainability of this expensive new technology

Transport Properties of a One-Dimensional Two-Component Quantum Liquid with Hyperbolic Interactions

We present an investigation of the sinh-cosh (SC) interaction model with twisted boundary conditions. We argue that, when unlike particles repel, the SC model may be usefully viewed as a Heisenberg-Ising fluid with moving Heisenberg-Ising spins. We derive the Luttinger liquid relation for the stiffness and the susceptibility, both from conformal arguments, and directly from the integral equations. Finally, we investigate the opening and closing of the ground state gaps for both SC and Heisenberg-Ising models, as the interaction strength is varied.Comment: 10 REVTeX pages + 4 uuencoded figures, UoU-002029

Five-year follow-up of participants diagnosed with chronic airflow obstruction in a South African Burden of Obstructive Lung Disease (BOLD) survey

Background. A community-based prevalence survey performed in two suburbs in Cape Town, South Africa (SA), in 2005, using the international Burden of Obstructive Lung Disease (BOLD) method, confirmed a prevalence of chronic airflow obstruction (CAO) in 23.1% of adults aged >40 years. Objectives. To study the clinical course and prognosis over 5 years of patients with CAO identified in the 2005 survey. Methods. Patients with CAO in 2005 were invited to participate. Standard BOLD and modified questionnaires were completed. Spirometry was performed using spirometers of the same make as in 2005. Results. Of 196 eligible participants from BOLD 2005, 45 (23.0%) had died, 8 from respiratory causes, 10 from cardiovascular causes and 6 from other known causes, while in 21 cases the cause of death was not known. On multivariate analysis, only age and Global initiative for Obstructive Lung Disease (GOLD) stage 4 disease at baseline were significantly associated with death. Of the 151 survivors, 11 (5.6% of the original cohort) were unavailable and 33 (16.8%) declined or had medical exclusions. One hundred and seven survivors were enrolled in the follow-up study (54.6%, median age 63.1 years, 45.8% males). Post-bronchodilator spirometry performed in 106 participants failed to confirm CAO, defined as a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of <0.7, in 16 participants (15.1%), but CAO was present in 90. The median decline in FEV1 was 28.9 mL/year (interquartile range –54.8 - 0.0) and was similar between GOLD stages. The median total decline in FVC was 75 mL, and was significantly greater in GOLD stage 1 (–350 mL) than in stages 2 or 3 (–80 mL and +140 mL, respectively; p<0.01). Fifty-eight participants with CAO in 2005 (64.4%) remained in the same GOLD stage, while 21 (23.3%) deteriorated and 11 (12.2%) improved by ≥1 stage. Only one-third were receiving any treatment for chronic obstructive pulmonary disease (COPD). Conclusions. The prevalence, morbidity and mortality of CAO and COPD in SA are high and the level of appropriate treatment is very low, pointing to underdiagnosis and inadequate provision of and access to effective treatments and preventive strategies for this priority chronic non-communicable disease.info:eu-repo/semantics/publishedVersio

Shockwave synthesis of a thallium-based superconductor with a novel defect microstructure

We report the shock-wave synthesis at a yield ≳80% by volume of the single copper layer thalliumsuperconductor of composition Tl2Ba2CuO6. The as-synthesized material displays zero resistance near 55 K and a diamagnetic onset to bulk superconductivity at 70 K. Lattice imaging indicates that the superconducting microcrystals consist of a novel defect microstructure involving an intergrowth of two copper-oxygen layers probably interleaved by partial thallium and barium occupancy

Environmental and Economically Conscious Magnesium Production: Solar Thermal Electrolytic Production of Mg from MgO

One method to improve the fuel efficiency of American made vehicles is to reduce vehicle weight by substituting steel components with lighter magnesium (Mg) components. Unfortunately, U.S. produced Mg currently costs approximately $3.31 per kg, over seven times the price of steel. Furthermore, Mg production has a staggering energy and environmental impact, consuming up to 102 kW-hr/kg-Mg of energy and producing 36 kg of CO2/kg-Mg. To reduce the overwhelming economic and environmental impact of Mg, a new solar thermal electrolytic process has been developed for the production of Mg from MgO. Through this process, liquid Mg is produced in a solar reactor utilizing both thermal and electrical energy. At elevated temperatures, the thermal energy from concentrated sunlight reduces the required electrical work below that of current processes. The reactor absorbs the concentrated solar energy, heating a molten salt-MgO mixture in an electrolytic cell. Electricity is then supplied to the cell, producing liquid Mg and CO. It is estimated that this new process will produce Mg at$2.50 per kg, with costs decreasing as the technology is further developed. This process requires approximately 8.3 kW-hr/kg-Mg of energy and produces only 3.44 kg of CO2/kg-Mg, large reductions compared to current processes

Systematic behaviour of the in-plane penetration depth in d-wave cuprates

We report the temperature T and oxygen concentration dependences of the penetration depth of grain-aligned YBa_2Cu_3O_{7-\delta} with \delta= 0.0, 0.3 and 0.43. The values of the in-plane \lambda_{ab}(0) and out-of-plane \lambda_{c}(0) penetration depths, the low temperature linear term in \lambda_{ab}(T), and the ratio \lambda_{c}(0) /\lambda_{ab}(T) were found to increase with increasing $\delta$. The systematic changes of the linear term in \lambda_{ab}(T) with T_c found here and in recent work on HgBa_2Ca_{n-1} Cu_nO_{2n+2+\delta} (n = 1 and 3) are discussed.Comment: 4 pages, 4 figure

Correlated local distortions of the TlO layers in Tl2_2Ba2_2CuOy_{y}: An x-ray absorption study

We have used the XAFS (x-ray-absorption fine structure) technique to investigate the local structure about the Cu, Ba, and Tl atoms in orthorhombic Tl-2201 with a superconducting transition temperature T$_c$=60 K. Our results clearly show that the O(1), O(2), Cu, and Ba atoms are at their ideal sites as given by the diffraction measurements, while the Tl and O(3) atoms are more disordered than suggested by the average crystal structure. The Tl-Tl distance at 3.5 \AA{ } between the TlO layers does not change, but the Tl-Tl distance at 3.9 \AA{ } within the TlO layer is not observed and the Tl-Ba and Ba-Tl peaks are very broad. The shorter Tl-O(3) distance in the TlO layer is about 2.33 \AA, significantly shorter than the distance calculated with both the Tl and O(3) atoms at their ideal $4e$ sites ( $x=y=$0 or $\frac{1}{2}$). A model based on these results shows that the Tl atom is displaced along the directions from its ideal site by about 0.11 \AA; the displacements of neighboring Tl atoms are correlated. The O(3) atom is shifted from the $4e$ site by about 0.53 \AA{ } roughly along the directions. A comparison of the Tl L$_{III}$-edge XAFS spectra from three samples, with T$_c$=60 K, 76 K, and 89 K, shows that the O environment around the Tl atom is sensitive to T$_c$ while the Tl local displacement is insensitive to T$_c$ and the structural symmetry. These conclusions are compared with other experimental results and the implications for charge transfer and superconductivity are discussed. This paper has been submitted to Phys. Rev. B.Comment: 20 pages plus 14 ps figures, REVTEX 3.