Eflornithine is a cost-effective alternative to melarsoprol for the treatment of second-stage human West African trypanosomiasis in Caxito, Angola.

OBJECTIVE: To compare the cost-effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis. METHOD: We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost-effectiveness analysis, comparing the efficiency of an eflornithine-based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included. RESULTS: Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost-effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included. CONCLUSION: Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost-effective. Switching from melarsoprol to eflornithine can be considered as a cost-effective option according to the WHO choice criteria

Effect of divalent cation ionophore (A 23187) on renal handling of phosphorus

Effect of divalent cation ionophore (A 23187) on renal handling of phosphorus. To evaluate the effect of an increase in intracellular calcium on renal handling of phosphorus, calcium ionophore, which facilitates passive entry of calcium into cytosol, was given i.v. to four groups of rats: group 1, animals with intact parathyroid glands; group 2, parathyroidectomized (PTX) rats; group 3, PTX animals receiving i.v. parathyroid hormone (PTH); and group 4, PTX animals pretreated with i.v. ionophore, then given i.v. PTH. During the administration of ionophore in group 1, serum calcium (Sca) decreased from 8.7 ± 0.2 (mean ±SEM) to 7.5 ± 0.2mg/100 ml (P < 0.001), fractional excretion of phosphorus (CP/CIn) decreased from 0.110 ± 0.020 to 0.019 ± 0.006 (P < 0.001), and urinary cyclic 3′, 5′-adenosine monophosphate (UcAMP) decreased from 131 ± 23 to 46 ± 16 pmoles/min (P < 0.0125). In group 2, during the administration of ionophore, Sca decreased from 6.5 ± 0.2 to 5.7 ± 0.2mg/100 ml (P < 0.001), but neither CP/CIn nor UcAMP were altered. In group 2, during the administration of ionophore, CP/Cm decreased from 0.43 ± 0.05 to 0.19 ± 0.04 (P < 0.005), UcAMP decreased from 254 ± 20 to 159 ± 11 (P < 0.001). In group 4, during combined i.v. administration of ionophore and PTH, CP/CIn was reduced from 0.19 ± 0.009 to 0.044 ± 0.012 (P < 0.005), and serum calcium was reduced from 6.5 ± 0.3 to 5.1 ± 0.3mg/100 ml (P < 0.01). These findings indicate that i.v. ionophore suppresses urinary excretion of phosphorus, only in the presence of either endogenous or exogenous PTH. The associated decrease in UcAMP suggests that this effect could be mediated through inhibition of PTH-dependent formation of cAMP, possibly resulting from the ionophore-induced increase in intracellular calcium in renal tubular cells.Effet d'un ionophore des cations divalents (A 23187) sur le comportement renal vis a vis du phosphate. Afin d'évaluer l'effet de l'augmentation du calcium intracellulaire sur le comportement rénal vis à vis du phosphore, on a donné à quatre groupes de rats un ionophore de calcium qui facilite l'entrée passive de ce cation dans le cytosol. Le groupe 1 est composé d'animaux dont les parathyroïdes sont intactes, le groupe 2 d'animaux parathyroïdectomisés (PTX), le groupe 3 d'animaux PTX recevant de l'hormone parathyroïdienne (PTH) par voie intra-veineuse et le groupe 4 d'animaux pré-traités par l'ionophore qui reçoivent de la PTH. Au cours de l'administration de l'ionophore au groupe 1, le calcium séreique (SCa) diminue de 8,7 ± 0,2 (m ±SEM) à 7,5 ± 0,2mg/100 ml (P < 0,001), l'excrétion fractionnelle du phosphore (CP/CIn) diminue de 0,110 ± 0,020 à 0,019 ± 0,006 (P < 0,001) et l'AMP cyclique urinaire (UcAMP) diminue de 131 ± 23 à 46 ± 16 pmoles/min (P < 0,0125).Dans le groupe 2, au cours de l'administration de l'ionophore, Sca diminue de 6,5 ± 0,2 a 5,7 ± 0,2 mg/100 ml (P < 0,001), mais ni CP/CIn ni UcAMP ne sont modifiés. Dans le groupe 3, au cours de l'administration de l'ionophore, CP/CIn diminue de 254 ± 20 à 159 ± 11 (P < 0,001). Dans le groupe 4, au cours de l'administration combinée d'ionophore et de PTH, CP/CIn diminue de 0,19 ± 0,009 à 0,004 ± 0,012 (P < 0,005) et Sca de 6,5 ± 0,3 à 5,1 ± 0,3 mg/100 ml (P < 0,01). Ces constatations indiquent que l'ionophore ne diminue l'excrétion urinaire de phosphate qu'en présence de PTH endogène ou exogène. La baisse associée de UcAMP suggère que cet effet peut avoir pour médiateur l'inhibition de la formation d'AMP cyclique dépendante de la PTH, conséquence de l'augmentation du calcium intracellulaire dans les cellules tubulaires rénales, induite par l'ionophore

Massive Star Forming Regions in the Galaxy using the Spitzer GLIMPSE Survey

We examine the thirteen most luminous sources in the WMAP free-free map using the Spitzer GLIMPSE and MSX surveys to identify massive star formation regions, emitting one-third of the Galactic free-free luminosity. We identify star forming regions by a combination of bubble morphology in 8 \micronm (PAH) emission and radio recombination line radial velocities. We find 40 star forming regions associated with our WMAP sources, and determine unique distances to 31. We interpret the bubbles as evidence for radial expansion. The radial velocity distribution for each source allows us to measure the intrinsic speed of a region's expansion. This speed is consistent with the size and age of the bubbles. The high free-free luminosities, combined with negligible synchrotron emission, demonstrate that the bubbles are not driven by supernovae. The kinetic energy of the largest bubbles is a substantial fraction of that measured in the older superbubbles found by Heiles. We find that the energy injected into the ISM by our bubbles is similar to that required to maintain the turbulent motion in the gas disk inside 8 kpc. We report a number of new star forming regions powered by massive (\textrm{M}_{*} > 10^4 \textrm{M}_\sun) star clusters. We measure the scale height of the Galactic O stars to be h_{\textrm{*}} = 35 \pm 5 \pc. We determine an empirical relationship between the PAH and free-free emission of the form $F_{\textrm{PAH}} \propto F^2_{\textrm{ff}}$. Finally, we find that the bubble geometry is more consistent with a spherical shell rather than a flattened disk.Comment: Submitted to ApJ; 29 Pages, 17 Figures, 5 Table

Ostracode-based aminostratigraphy and aminochronology of a tufa system in central Spain

In the Priego area, central Spain, extensive tufa deposits are located in three small tributaries located at the head of the 1000 kmlong Tagus River. The deposits are originated after karst-origin running waters emerged from the confines of the canyons and expanded outward. Old tufa deposits of Priego are mainly present as terraced alluvial plain deposits where different autochthonous and allochthonous facies appear. Extraclastic deposits of quartzite and limestone clasts derived from Mesozoic rocks are interbedded with the tufa marking pulsatory high-flow periods. Using the geomorphologic analysis six terraced levels were differentiated and sampled for ostracode amino acid racemization analysis. D/L ratios of aspartic acid and glutamic acid were used for dating purposes. Cluster analysis defined six aminozones (AMI-AM7) which were dated as follows: AMI: 407 ± 12 ka oxygen isotope stages (OIS 11); AM2: 263 ± 14 ka (OIS 7e); AM3: 181 ± 17 ka (OIS 7a); AM4: 136± 13 ka (OIS 5-6); AM5: 108 ± 14 ka (OIS 5); AM7: 11 ± 4 ka (OIS 1), indicating that tufa deposition took place during warm periods. Models of riverine and riverinebarrage tufa accumulation indicate that their maximum build-up took place between the canyon mouth and the point of depletion of dissolved CO2, and this affected the elevation of the top of the deposits and their relative chronology

Semi-classical Quantization in N=4 Supersymmetric Yang-Mills Theory and Duality

At a generic point in the moduli space of vacua of an N=4 supersymmetric gauge theory with arbitrary gauge group the Higgs force does not cancel the magneto-static force between magnetic monopoles of distinct charge. As a consequence the moduli space of magnetically charged solutions is related in a simple way to those of the SU(2) theory. This leads to a rather simple test of S-duality. On certain subspaces of the moduli space of vacua the forces between distinct monopoles cancel and the test of S-duality becomes more complicated.Comment: 11 pages, plain tex with macro included, one Postscript figure, uses psfig.te

Critical-Sized Bone Defects: Sequence and Planning.

Bone defects associated with open fractures require a careful approach and planning. At initial presentation, an emergent irrigation and debridement is required. Immediate definitive fixation is frequently safe, with the exception of those injuries that normally require staged management or very severe type IIIB and IIIC injuries. Traumatic wounds that can be approximated primarily should be closed at the time of initial presentation. Wounds that cannot be closed should have a negative pressure wound therapy dressing applied. The need for subsequent debridements remains a clinical judgment, but all nonviable tissue should be removed before definitive coverage. Cefazolin remains the standard of care for all open fractures, and type III injuries also require gram-negative coverage. Both induced membrane technique with staged bone grafting and distraction osteogenesis are excellent options for bony reconstruction. Soft tissue coverage within 1 week of injury seems critical

Duality and Supersymmetric Monopoles

Exact duality in supersymmetric gauge theories leads to highly non-trivial predictions about the moduli spaces of BPS monopole solutions. These notes attempt to be a pedagogical review of the current status of these investigations and are based on lectures given at the 33rd Karpacz Winter School: Duality - Strings and Fields, February 1997.Comment: Latex, 12 pages. Typos corrected, references adde

Ubiquitous equatorial accretion disc winds in black hole soft states

High resolution spectra of Galactic Black Holes (GBH) reveal the presence of highly ionised absorbers. In one GBH, accreting close to the Eddington limit for more than a decade, a powerful accretion disc wind is observed to be present in softer X-ray states and it has been suggested that it can carry away enough mass and energy to quench the radio jet. Here we report that these winds, which may have mass outflow rates of the order of the inner accretion rate or higher, are an ubiquitous component of the jet-free soft states of all GBH. We furthermore demonstrate that these winds have an equatorial geometry with opening angles of few tens of degrees, and so are only observed in sources in which the disc is inclined at a large angle to the line of sight. The decrease in Fe XXV / Fe XXVI line ratio with Compton temperature, observed in the soft state, suggests a link between higher wind ionisation and harder spectral shapes. Although the physical interaction between the wind, accretion flow and jet is still not fully understood, the mass flux and power of these winds, and their presence ubiquitously during the soft X-ray states suggests they are fundamental components of the accretion phenomenon.Comment: Accepted for publication in MNRAS Letter