58 research outputs found

    Cost-per-diagnosis as a metric for monitoring cost effectiveness of HIV testing programmes in low income settings in southern Africa : health economic and modelling analysis

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    Introduction: As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost effective. To guide their HIV testing programmes,countries require appropriatemetrics that can be measured. The cost-per-diagnosisis potentially a useful metric. Methods:We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of “core” testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) “core” testing as above plus “additional-testing”, for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than thosewithout HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosisand the incremental cost-effectiveness ratio(ICER) of the additional-testingpolicy. Discount rate 3%; costs in 2018 US.Results:TherewasastronggradedrelationshipbetweenthecostperdiagnosisandtheICER.Overall,theICERwasbelowUS. Results:There was a strong graded relationship between the cost-per-diagnosisand the ICER. Overall, the ICERwas below 500 per-DALY-averted (the cost effectiveness threshold used in primary analysis) so long as thecost-per-diagnosiswas below 315.ThisthresholdcostperdiagnosiswassimilaraccordingtoepidemicandprogrammaticfeaturesincludingtheprevalenceofundiagnosedHIV,theHIVincidenceandameasureofHIVprogrammequality(theproportionofHIVdiagnosedpeoplehavingaviralload<1000copies/mL).However,restrictingtowomen,additionaltestingdidnotappearcosteffectiveevenatacostperdiagnosisofbelow315. This thresholdcost-per-diagnosiswas similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restrictingto women, additional-testingdid not appear cost-effective even at acost-per-diagnosisof below 50, while restrictingto men additional-testingwas cost effective up to a cost-per-diagnosisof 585.Thethresholdcostfortestinginmenfellto585. Thethreshold cost for testing in men fell to 256 when the cost effectiveness threshold was 300insteadof300instead of 500, and to $81 when considering a discount rate of 10% perannum.Conclusions:For testing programmesin low income settings in southern African there is an extremely strong relationship between the cost-per-diagnosisand the cost per DALY averted, indicating that the cost-per-diagnosiscan be used to monitor the cost effectiveness of testing programmes

    Exceptional Diversity, Non-Random Distribution, and Rapid Evolution of Retroelements in the B73 Maize Genome

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    Recent comprehensive sequence analysis of the maize genome now permits detailed discovery and description of all transposable elements (TEs) in this complex nuclear environment. Reiteratively optimized structural and homology criteria were used in the computer-assisted search for retroelements, TEs that transpose by reverse transcription of an RNA intermediate, with the final results verified by manual inspection. Retroelements were found to occupy the majority (>75%) of the nuclear genome in maize inbred B73. Unprecedented genetic diversity was discovered in the long terminal repeat (LTR) retrotransposon class of retroelements, with >400 families (>350 newly discovered) contributing >31,000 intact elements. The two other classes of retroelements, SINEs (four families) and LINEs (at least 30 families), were observed to contribute 1,991 and ∼35,000 copies, respectively, or a combined ∼1% of the B73 nuclear genome. With regard to fully intact elements, median copy numbers for all retroelement families in maize was 2 because >250 LTR retrotransposon families contained only one or two intact members that could be detected in the B73 draft sequence. The majority, perhaps all, of the investigated retroelement families exhibited non-random dispersal across the maize genome, with LINEs, SINEs, and many low-copy-number LTR retrotransposons exhibiting a bias for accumulation in gene-rich regions. In contrast, most (but not all) medium- and high-copy-number LTR retrotransposons were found to preferentially accumulate in gene-poor regions like pericentromeric heterochromatin, while a few high-copy-number families exhibited the opposite bias. Regions of the genome with the highest LTR retrotransposon density contained the lowest LTR retrotransposon diversity. These results indicate that the maize genome provides a great number of different niches for the survival and procreation of a great variety of retroelements that have evolved to differentially occupy and exploit this genomic diversity

    Increasing the use of second-line therapy is a cost-effective approach to prevent the spread of drug-resistant HIV: a mathematical modelling study

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    METHODS: We develop a deterministic mathematical model representing Kampala, Uganda, to predict the prevalence of TDR over a 10-year period. We then compare the impact on TDR and cost-effectiveness of: (1) introduction of pre-therapy genotyping; (2) doubling use of second-line treatment to 80% (50-90%) of patients with confirmed virological failure on first-line ART; and (3) increasing viral load monitoring from yearly to twice yearly. An intervention can be considered cost-effective if it costs less than three times the gross domestic product per capita per quality adjusted life year (QALY) gained, or less than 3420inUganda.RESULTS:TheprevalenceofTDRispredictedtorisefrom6.73420 in Uganda.RESULTS: The prevalence of TDR is predicted to rise from 6.7% (interquartile range [IQR] 6.2-7.2%) in 2014, to 6.8% (IQR 6.1-7.6%), 10.0% (IQR 8.9-11.5%) and 11.1% (IQR 9.7-13.0%) in 2024 if treatment is initiated at a CD4 <350, <500, or immediately, respectively. The absolute number of TDR cases is predicted to decrease 4.4-8.1% when treating earlier compared to treating at CD4 <350 due to the preventative effects of earlier treatment. Most cases of TDR can be averted by increasing second-line treatment (additional 7.1-10.2% reduction), followed by increased viral load monitoring (<2.7%) and pre-therapy genotyping (<1.0%). Only increasing second-line treatment is cost-effective, ranging from 1612 to 2234(IQR2234 (IQR 450-dominated) per QALY gained.CONCLUSIONS: While earlier treatment initiation will result in a predicted increase in the proportion of patients infected with drug-resistant HIV, the absolute numbers of patients infected with drug-resistant HIV is predicted to decrease. Increasing use of second-line treatment to all patients with confirmed failure on first-line therapy is a cost-effective approach to reduce TDR. Improving access to second-line ART is therefore a major priority.INTRODUCTION: Earlier antiretroviral therapy (ART) initiation reduces HIV-1 incidence. This benefit may be offset by increased transmitted drug resistance (TDR), which could limit future HIV treatment options. We analyze the epidemiological impact and cost-effectiveness of strategies to reduce TDR

    Analysis of the melon (Cucumis melo) small RNAome by high-throughput pyrosequencing

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    Abstract Background Melon (Cucumis melo L.) is a commercially important fruit crop that is cultivated worldwide. The melon research community has recently benefited from the determination of a complete draft genome sequence and the development of associated genomic tools, which have allowed us to focus on small RNAs (sRNAs). These are short, non-coding RNAs 21-24 nucleotides in length with diverse physiological roles. In plants, they regulate gene expression and heterochromatin assembly, and control protection against virus infection. Much remains to be learned about the role of sRNAs in melon. Results We constructed 10 sRNA libraries from two stages of developing ovaries, fruits and photosynthetic cotyledons infected with viruses, and carried out high-throughput pyrosequencing. We catalogued and analysed the melon sRNAs, resulting in the identification of 26 known miRNA families (many conserved with other species), the prediction of 84 melon-specific miRNA candidates, the identification of trans-acting siRNAs, and the identification of chloroplast, mitochondrion and transposon-derived sRNAs. In silico analysis revealed more than 400 potential targets for the conserved and novel miRNAs. Conclusion We have discovered and analysed a large number of conserved and melon-specific sRNAs, including miRNAs and their potential target genes. This provides insight into the composition and function of the melon small RNAome, and paves the way towards an understanding of sRNA-mediated processes that regulate melon fruit development and melon-virus interactions.This work was supported by grants AGL2009-07552/AGR, BIO2006-13107 (Ministerio de Ciencia e Innovación, Spain) and MELONOMICS (Fundación Genoma España, Spain).Peer Reviewe

    Conservation Status and Threat Assessments for North American Crop Wild Relatives

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    Conservation status and threat assessments evaluate species’ relative risks of extinction globally, regionally, nationally, or locally and estimate the degree to which populations of species are already safeguarded in existing conservation systems, with the aim of exposing the critical gaps in current conservation. Results of the assessments can therefore aid in directing limited conservation resources to the species and populations that are most at-risk. This chapter introduces the roles of conservation status and threat assessments in informing conservation priorities for crop wild relatives in North America and provides an overview of the current results for US taxa. Methods to assess the conservation status and to perform threat assessments for North American crop wild relatives are well developed via NatureServe and the International Union for Conservation of Nature (IUCN) Red List, and the essential infrastructure to perform these analyses is present, at least in Canada and the US. Current conservation assessments for North American wild relatives need updating but already reveal a landscape of multiple complex threats and major gaps in the ex situ and in situ conservation of prioritized species. Further resources and concerted efforts are needed to update conservation assessments and then to use the results to inform efforts to fill the critical gaps in conservation

    Seventeenth-century approaches to the devil’s law-case

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    Long Term Corrosion Potential and Corrosion Rate of Creviced Alloy 22 in Chloride Plus Nitrate Brines LONG TERM CORROSION POTENTIAL AND CORROSION RATE OF CREVICED ALLOY 22 IN CHLORIDE PLUS NITRATE BRINES

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    ABSTRACT Alloy 22 is a nickel base alloy highly resistant to all forms of corrosion. In conditions where tight crevices exist in hot chloride containing solutions and at anodic potentials, Alloy 22 may suffer crevice corrosion, a form of localized attack. The occurrence (or not) of crevice corrosion in a given environment (e.g. salt concentration and temperature), is governed by the values of the critical potential (E crit ) for crevice corrosion and the corrosion potential (E corr ) that the alloy may establish in the studied environment. If E corr is equal or higher than E crit , crevice corrosion may be expected. In addition, it is generally accepted that as Alloy 22 becomes passive in a certain environment, its E corr increases and its corrosion rate (CR) decreases. This paper discusses the evolution of E corr and corrosion rate (CR) of creviced Alloy 22 specimens in six different mixtures of sodium chloride (NaCl) and potassium nitrate (KNO 3 ) at 100°C. The effect of immersion time on the value of E crit was also determined. Two types of specimens were used, polished as-welded (ASW) and as-welded plus solution heat-treated (ASW+SHT). The latter contained the black annealing oxide film on the surface. Results show that, as the immersion time increases, E corr increased and the CR decreased. Even for highly concentrated brine solutions at 100°C the CR was &lt; 30 nm/year after more than 250 days immersion. Some of the exposed specimens (mainly the SHT specimens) suffered crevice corrosion at the open circuit potential in the naturally aerated brines. Immersion times of over 250 days did not reduce the resistance of Alloy 22 to localized corrosion
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