Cost-Effectiveness Analysis of Diagnostic Options for Pneumocystis Pneumonia (PCP)

Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented.We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77-90% of patients at $26-51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68-90$189-232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68$109 per life-year gained) compared with several molecular diagnostic options.For diagnosis of PCP, use of PCR technologies, when combined with less-invasive patient specimens such as expectorated or induced sputum, represent more cost-effective options than any diagnostic procedure using BAL, or chest x-ray alone

Contourite drift evolution and related coral growth in the eastern Gulf of Mexico and its gateways

Sediment subbottom profiler and multi-beam data reveal that sediment drifts evolved in various depth intervals between 420 and 650 m water depth in the eastern Golf of Mexico and its gateways. Drift evolution on the western flank of the Yucatan Strait is controlled by the northbound Loop Current down to 800 m and by a countercurrent beneath. On the northern Campeche Bank and the West Florida Slope, drifts evolved in depth of 520–600 m and 420–550 m, respectively. In both instances, the causative contour current represents a counter flow to the Loop Current. The varying depth ranges correlate with an eastward rise of the upper boundary of the Antarctic Intermediate Water. The geometry and reflection pattern of upper slope deposits strongly suggest that the causative bottom current velocities in the eastern Gulf of Mexico varied significantly in space and time. The subbottom profiler data further show peculiar stacked diffraction hyperbolae in depths between 480 and 600 m. Camera and video observations from the seafloor off western Florida imply that the diffraction hyperbolas are formed by boulders and cliffs of sedimentary rock, which are locally colonized by coldwater corals, such as Lophelia pertusa, octocorals and stylasterids