Assessing Health and Economic Outcomes of Interventions to Reduce Pregnancy-Related Mortality in Nigeria

Background: Women in Nigeria face some of the highest maternal mortality risks in the world. We explore the benefits and cost-effectiveness of individual and integrated packages of interventions to prevent pregnancy-related deaths. Methods: We adapt a previously validated maternal mortality model to Nigeria. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to Southwest and Northeast zones using survey-based data. Strategies consisted of improving coverage of effective interventions, and could include improved logistics. Results: Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality, was cost saving in the Southwest zone and cost-effective elsewhere, and prevented nearly 1 in 5 abortion-related deaths. However, with a singular focus on family planning and safe abortion, mortality reduction would plateau below MDG 5. Strategies that could prevent 4 out of 5 maternal deaths included an integrated and stepwise approach that includes increased skilled deliveries, facility births, access to antenatal/postpartum care, improved recognition of referral need, transport, and availability quality of EmOC in addition to family planning and safe abortion. The economic benefits of these strategies ranged from being cost-saving to having incremental cost-effectiveness ratios less than $500 per YLS, well below Nigeria’s per capita GDP. Conclusions: Early intensive efforts to improve family planning and control of fertility choices, accompanied by a stepwise effort to scale-up capacity for integrated maternal health services over several years, will save lives and provide equal or greater value than many public health interventions we consider among the most cost-effective (e.g., childhood immunization)

Suppressed-gap millimetre wave kinetic inductance detectors using DC-bias current

Funder: CSC Cambridge ScholarshipAbstract: In this study, we evaluate the suitability of using DC-biased aluminium resonators as low-frequency kinetic inductance detectors capable of operating in the frequency range of 50–120 GHz. Our analysis routine for supercurrent-biased resonators is based on the Usadel equations and gives outputs including density of states, complex conductivities, transmission line properties, and quasiparticle lifetimes. Results from our analysis confirm previous experimental observations on resonant frequency tuneability and retention of high quality factor. Crucially, our analysis suggests that DC-biased resonators demonstrate significantly suppressed superconducting density of states gap. Consequently these resonators have lower frequency detection threshold and are suitable materials for low-frequency kinetic inductance detectors

The Evolving Role of Maintenance Therapy Using Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors (EGFR TKIs) in the Management of Advanced Non-Small-Cell Lung Cancer

A video abstract by the authors of this paper is available. video-abstract5127.mo

Modelling chemotherapy resistance in palliation and failed cure

The goal of palliative cancer chemotherapy treatment is to prolong survival and improve quality of life when tumour eradication is not feasible. Chemotherapy protocol design is considered in this context using a simple, robust, model of advanced tumour growth with Gompertzian dynamics, taking into account the effects of drug resistance. It is predicted that reduced chemotherapy protocols can readily lead to improved survival times due to the effects of competition between resistant and sensitive tumour cells. Very early palliation is also predicted to quickly yield near total tumour resistance and thus decrease survival duration. Finally, our simulations indicate that failed curative attempts using dose densification, a common protocol escalation strategy, can reduce survival times

The Causal Structure of Emotions in Aristotle: Hylomorphism, Causal Interaction between Mind and Body, and Intentionality

Recently, a strong hylomorphic reading of Aristotelian emotions has been put forward, one that allegedly eliminates the problem of causal interaction between soul and body. Taking the presentation of emotions in de An. I 1 as a starting point and basic thread, but relying also on the discussion of Rh. II, I will argue that this reading only takes into account two of the four causes of emotions, and that, if all four of them are included into the picture, then a causal interaction of mind and body remains within Aristotelian emotions, independent of how strongly their hylomorphism is understood. Beyond the discussion with this recent reading, the analysis proposed of the fourfold causal structure of emotions is also intended as a hermeneutical starting point for a comprehensive analysis of particular emotions in Aristotle. Through the different causes Aristotle seems to account for many aspects of the complex phenomenon of emotion, including its physiological causes, its mental causes, and its intentional object

Application of Confocal Laser Scanning Microscopy to Cytocompatibility Testing of Potential Orthopaedic Materials in Immortalised Osteoblast-Like Cell Lines

Confocal laser scanning microscopy (CLSM) was used in conjunction with in vitro cell culture to investigate cellular interactions with orthopaedic biomaterials. Transfected rat and human osteoblasts were seeded on two potential isoelastic hip prosthesis materials, carbon fibre reinforced polyetheretherketone (PEEK) and epoxy. Titanium 318 alloy was employed as a control. Determination of the material surface contour, an important factor influencing cellular adhesion, proliferation and function, was performed using the industry standard Talysurf® and compared to analogous results obtained using the CLSM. The latter technique consistently gave higher values of material roughness but offers the advantage that it can be used to correlate roughness with cell distribution on the same samples, whereas Talysurf® measurement of roughness requires clean rigid samples. Image analysis and processing, performed on cells after attachment and culture on the materials for 48 hours, provided cell morphology data. Cells cultured on titanium were larger, with a higher percentage of cytoplasm, than those grown on either of the other materials. The macroscopic surface of epoxy resulted in smaller cells with altered morphology, which orientated themselves along carbon fibres. In conclusion, we believe CLSM offers great potential for investigating the cellular interactions of biomaterials involving minimal sample preparation, non-invasive optical sectioning of samples and minimal opportunity for generation of cellular deformation and sample preparation artefacts

Sustainable Affordable Housing - Submission to Inquiry into First Home Ownership

The Institute welcomes this opportunity to submit comments to the Commissions Inquiry evaluating the affordability and availability of housing for first home buyers. The Institute for Sustainable Futures is a self-funded research and consulting institute of the University of Technology, Sydney. The Institutes mission is to support and create change towards sustainable futures by working with government, industry and the community. Social sustainability, sustainable housing and sustainable urban infrastructure for energy, water and transport are all key parts of this mission.1 This submission seeks to evaluate the affordability and availability of housing for first home buyers within the framework of ecologically sustainable development (ESD). It is in two parts. Part I: Submission provides the framework. Part II: Comments on the Commissions Issues Paper provides more details on this framework under the broad headings used in the Commissions Issues Paper

CLOVER - A new instrument for measuring the B-mode polarization of the CMB

We describe the design and expected performance of Clover, a new instrument designed to measure the B-mode polarization of the cosmic microwave background. The proposed instrument will comprise three independent telescopes operating at 90, 150 and 220 GHz and is planned to be sited at Dome C, Antarctica. Each telescope will feed a focal plane array of 128 background-limited detectors and will measure polarized signals over angular multipoles 20 < l < 1000. The unique design of the telescope and careful control of systematics should enable the B-mode signature of gravitational waves to be measured to a lensing-confusion-limited tensor-to-scalar ratio r~0.005.Comment: 4 pages, 5 figures. To appear in the proceedings of the XXXVIXth Rencontres de Moriond "Exploring the Universe

Potential Impact of Antiretroviral Therapy and Screening on Cervical Cancer Mortality in HIV-Positive Women in Sub-Saharan Africa: A Simulation

Despite having high cervical cancer incidence and mortality rates, screening for cervical precancerous lesions remains infrequent in sub-Saharan Africa. The need to screen HIV-positive women because of the higher prevalence and faster progression of cervical precancerous lesions may be heightened by the increased access to highly-active antiretroviral therapy (HAART). Policymakers need quantitative data on the effect of HAART and screening to better allocate limited resources. Our aim was to quantify the potential effect of these interventions on cervical cancer mortality.We constructed a Markov state-transition model of a cohort of HIV-positive women in Cameroon. Published data on the prevalence, progression and regression of lesions as well as mortality rates from HIV, cervical cancer and other causes were incorporated into the model. We examined the potential impact, on cumulative cervical cancer mortality, of four possible scenarios: no HAART and no screening (NHNS), HAART and no screening (HNS), HAART and screening once on HAART initiation (HSHI), and HAART and screening once at age 35 (HS35). Our model projected that, compared to NHNS, lifetime cumulative cervical cancer mortality approximately doubled with HNS. It will require 262 women being screened at HAART initiation to prevent one cervical cancer death amongst women on HAART. The magnitudes of these effects were most sensitive to the rate of progression of precancerous lesions.Screening, even when done once, has the potential of reducing cervical cancer mortality among HIV-positive women in Africa. The most feasible and cost-effective screening strategy needs to be determined in each setting