Costs and Consequences: Hepatitis C Seroprevalence in the Military and Its Impact on Potential Screening Strategies

UNLABELLED: Knowledge of the contemporary epidemiology of hepatitis C viral (HCV) infection among military personnel can inform potential Department of Defense screening policy. HCV infection status at the time of accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period 2007-2010. A cost model was developed from the perspective of the Department of Defense for a military applicant screening program. Return on investment was based on comparison between screening program costs and potential treatment costs avoided. The prevalence of HCV antibody-positive and chronic HCV infection at accession among younger recently deployed military personnel born after 1965 was 0.98/1000 (95% confidence interval 0.45-1.85) and 0.43/1000 (95% confidence interval 0.12-1.11), respectively. Among these, service-related incidence was low; 64% of infections were present at the time of accession. With no screening, the cost to the Department of Defense of treating the estimated 93 cases of chronic HCV cases from a single year\u27s accession cohort was $9.3 million. Screening with the HCV antibody test followed by the nucleic acid test for confirmation yielded a net annual savings and a$3.1 million dollar advantage over not screening. CONCLUSIONS: Applicant screening will reduce chronic HCV infection in the force, result in a small system costs savings, and decrease the threat of transfusion-transmitted HCV infection in the battlefield blood supply and may lead to earlier diagnosis and linkage to care; initiation of an applicant screening program will require ongoing evaluation that considers changes in the treatment cost and practice landscape, screening options, and the epidemiology of HCV in the applicant/accession and overall force populations

The Aquarius Ocean Salinity Mission High Stability L-band Radiometer

The NASA Earth Science System Pathfinder (ESSP) mission Aquarius, will measure global ocean surface salinity with approx.120 km spatial resolution every 7-days with an average monthly salinity accuracy of 0.2 psu (parts per thousand). This requires an L-band low-noise radiometer with the long-term calibration stability of less than or equal to 0.15 K over 7 days. The instrument utilizes a push-broom configuration which makes it impractical to use a traditional warm load and cold plate in front of the feedhorns. Therefore, to achieve the necessary performance Aquarius utilizes a Dicke radiometer with noise injection to perform a warm - hot calibration. The radiometer sequence between antenna, Dicke load, and noise diode has been optimized to maximize antenna observations and therefore minimize NEDT. This is possible due the ability to thermally control the radiometer electronics and front-end components to 0.1 Crms over 7 days

Hepatitis B Seroprevalence in the U.S. Military and its Impact on Potential Screening Strategies

INTRODUCTION: Knowledge of the contemporary epidemiology of hepatitis B virus (HBV) infection among military personnel can inform potential Department of Defense (DoD) screening policy and infection and disease control strategies. MATERIALS AND METHODS: HBV infection status at accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period from 2007 to 2010. A cost model was developed from the perspective of the Department of Defense for a program to integrate HBV infection screening of applicants for military service into the existing screening program of screening new accessions for vaccine-preventable infections. RESULTS: The prevalence of chronic HBV infection at accession was 2.3/1,000 (95% CI: 1.4, 3.2); most cases (16/21, 76%) identified after deployment were present at accession. There were 110 military service-related HBV infections identified. Screening accessions who are identified as HBV susceptible with HBV surface antigen followed by HBV surface antigen neutralization for confirmation offered no cost advantage over not screening and resulted in a net annual increase in cost of $5.78 million. However, screening would exclude as many as 514 HBV cases each year from accession. CONCLUSIONS: Screening for HBV infection at service entry would potentially reduce chronic HBV infection in the force, decrease the threat of transfusion-transmitted HBV infection in the battlefield blood supply, and lead to earlier diagnosis and linkage to care; however, applicant screening is not cost saving. Service-related incident infections indicate a durable threat, the need for improved laboratory-based surveillance tools, and mandate review of immunization policy and practice

DIRECT trial. Diverticulitis recurrences or continuing symptoms: Operative versus conservative Treatment. A MULTICENTER RANDOMISED CLINICAL TRIAL

Background: Persisting abdominal complaints are common after an episode of diverticulitis treated conservatively. Furthermore, some patients develop frequent recurrences. These two groups of patients suffer greatly from their disease, as shown by impaired health related quality of life and increased costs due to multiple specialist consultations, pain medication and productivity losses. Both conservative and operative management of patients with persisting abdominal complaints after an episode of diverticulitis and/or frequently recurring diverticulitis are applied. However, direct comparison by a randomised controlled trial is necessary to determine which is superior in relieving symptoms, optimising health related quality of life, minimising costs and preventing diverticulitis recurrences against acceptable morbidity and mortality associated with surgery or the occurrence of a complicated recurrence after conservative management. We, therefore, constructed a randomised clinical trial comparing these two treatment strategies. Methods/design: The DIRECT trial is a multicenter randomised clinical trial. Patients (18-75 years) presenting themselves with persisting abdominal complaints after an episode of diverticulitis and/or three or more recurrences within 2 years will be included and randomised. Patients randomised for conservative treatment are treated according to the current daily practice (antibiotics, analgetics and/or expectant management). Patients randomised for elective resection will undergo an elective resection of the affected colon segment. Preferably, a laparoscopic approach is used. The primary outcome is health related quality of life measured by the Gastro-intestinal Quality of Life Index, Short-Form 36, EQ-5D and a visual analogue scale for pain quantification. Secondary endpoints are morbidity, mortality and total costs. The total follow-u

Salted roads lead to oedema and reduced locomotor function in amphibian populations

Human activities have caused massive losses of natural populations across the globe. Like many groups, amphibians have experienced substantial declines worldwide, driven by environmental changes such as habitat conversion, pollution, and disease emergence. Each of these drivers is often found in close association with the presence of roads. Here we report a novel consequence of roads affecting an amphibian native to much of North America, the wood frog (Rana sylvatica). Across 38 populations distributed from southern to central New England, we found that adult wood frogs living adjacent to roads had higher incidence and severity of oedema (indicated by obvious bloating caused by subcutaneous fluid accumulation) during the breeding season than frogs living away from the influence of roads. This effect was best explained by increased conductivity of breeding ponds, prob-ably caused by runoff pollution from road salt used for de-icing. Oedema severity was negatively correlated with locomotor performance in more northerly populations. Interestingly, northern populations experience more intense winters, which tends to result in more de-icing salt runoff and increased energetic demands associated with overwintering cryoprotection needs. Thus, this emerging consequence of roads appears to impose potential fitness costs associated with locomotion, and these effects might be most impactful on populations living in regions where de-icing is most intense.Together, our findings reveal a novel set of impacts of roads and runoff pollution on wood frog physiology and performance, which seem likely to contribute to population decline. Given the global prevalence of roads and increasing salinisation of freshwater habitats, oedema and related impacts could be widespread consequences faced by amphibian populations across much of the planet's temperate zonesThis work was supported by Mianus River Gorge Preserve, Elm City Innovation Collaborative, Yale Institute for Biospheric Studies, EEES Graduate fellowship and Cramer funds, Guarini School of Graduate and Advanced Studies McCulloch Fellowship, CAPES graduate fellowship (SwB 13442/13-9), the Margarita Salas Fellowship, and the National Science Foundation (DEB #1011335, DEB #1655092).Peer reviewe

CFD Analysis of Coolant Mixing in VVER-1000/V320 Reactor Pressure Vessel

International audienceThis study presents a code-to-code and model-to-model comparison of coolant mixing in the VVER-1000/V320 Kozloduy Unit 6 nuclear power plant using Computational Fluid Dynamics (CFD). Four different CFD codes were used to simulate coolant mixing in the reactor vessel, namely ANSYS Fluent, ANSYS CFX, TrioCFD, and STAR-CCM+. Two different approaches were used to model the upper plenum, while a single simplified model was used for the reactor pressure vessel. The simulations were performed for VVER-1000 coolant transient benchmark (V1000CT-2) mixing exercise. The results were compared between the different CFD codes and models to assess the accuracy and consistency of the simulations with the available experimental data. Overall, the results showed good agreement between the different CFD codes and models, with minor differences observed in some cases. The simplified models were found to be sufficient for predicting the overall coolant mixing patterns observed in the reactor vessel, provided additional insights into the local flow structures and mixing characteristics. This study demonstrates the applicability and reliability of CFD simulations for coolant mixing analysis in VVER-1000/V320 nuclear power plants

Costs and consequences: Hepatitis C seroprevalence in the military and its impact on potential screening strategies

UNLABELLED: Knowledge of the contemporary epidemiology of hepatitis C viral (HCV) infection among military personnel can inform potential Department of Defense screening policy. HCV infection status at the time of accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period 2007-2010. A cost model was developed from the perspective of the Department of Defense for a military applicant screening program. Return on investment was based on comparison between screening program costs and potential treatment costs avoided. The prevalence of HCV antibody-positive and chronic HCV infection at accession among younger recently deployed military personnel born after 1965 was 0.98/1000 (95% confidence interval 0.45-1.85) and 0.43/1000 (95% confidence interval 0.12-1.11), respectively. Among these, service-related incidence was low; 64% of infections were present at the time of accession. With no screening, the cost to the Department of Defense of treating the estimated 93 cases of chronic HCV cases from a single year\u27s accession cohort was $9.3 million. Screening with the HCV antibody test followed by the nucleic acid test for confirmation yielded a net annual savings and a$3.1 million dollar advantage over not screening. CONCLUSIONS: Applicant screening will reduce chronic HCV infection in the force, result in a small system costs savings, and decrease the threat of transfusion-transmitted HCV infection in the battlefield blood supply and may lead to earlier diagnosis and linkage to care; initiation of an applicant screening program will require ongoing evaluation that considers changes in the treatment cost and practice landscape, screening options, and the epidemiology of HCV in the applicant/accession and overall force populations