The cost effectiveness of integrated care for people living with HIV including antiretroviral treatment in a primary health care centre in Bujumbura, Burundi

The incremental cost effectiveness of an integrated care package (i.e., medical care including antiretroviral therapy (ART) and other services such as psychological and social support) for people living with HIV/AIDS was calculated in a not-for-profit primary health care centre in Bujumbura run by Society of Women against AIDS-Burundi (SWAA-Burundi), an African non-governmental organisation (NGO). Results are expressed as cost-effectiveness ratio 2007, constant US$per disability-adjusted life year (DALY) averted. Unit costs are estimated from the NGO's accounting data and activity reports, healthcare utilisation is estimated from the medical records of a cohort of 149 patients. Effectiveness is modelled on the survival of this cohort, using standard calculation methods. The incremental cost of integrated care for people living with HIV/AIDS in the Bujumbura health centre of SWAA-Burundi is 258 US$ per DALY averted. The package of care provided by SWAA-Burundi is therefore a very cost-effective intervention in comparison with other interventions against HIV/AIDS that include ART. It is however, less cost effective than other types of interventions against HIV/AIDS, such as preventive activities

Wavelets: mathematics and applications

The notion of wavelets is defined. It is briefly described {\it what} are wavelets, {\it how} to use them, {\it when} we do need them, {\it why} they are preferred and {\it where} they have been applied. Then one proceeds to the multiresolution analysis and fast wavelet transform as a standard procedure for dealing with discrete wavelets. It is shown which specific features of signals (functions) can be revealed by this analysis, but can not be found by other methods (e.g., by the Fourier expansion). Finally, some examples of practical application are given (in particular, to analysis of multiparticle production}. Rigorous proofs of mathematical statements are omitted, and the reader is referred to the corresponding literature.Comment: 16 pages, 5 figures, Latex, Phys. Atom. Nuc

s-Process Nucleosynthesis in Advanced Burning Phases of Massive Stars

We present a detailed study of s-process nucleosynthesis in massive stars of solar-like initial composition and masses 15, 20,25, and 30 Msun. We update our previous results of s-process nucleosynthesis during the core He-burning of these stars and then focus on an analysis of the s-process under the physical conditions encountered during the shell-carbon burning. We show that the recent compilation of the Ne22(alpha,n)Mg25 rate leads to a remarkable reduction of the efficiency of the s-process during core He-burning. In particular, this rate leads to the lowest overproduction factor of Kr80 found to date during core He-burning in massive stars. The s-process yields resulting from shell carbon burning turn out to be very sensitive to the structural evolution of the carbon shell. This structure is influenced by the mass fraction of C12 attained at the end of core helium burning, which in turn is mainly determined by the C12(alpha,gamma)O16 reaction. The still present uncertainty in the rate for this reaction implies that the s-process in massive stars is also subject to this uncertainty. We identify some isotopes like Zn70 and Rb87 as the signatures of the s-process during shell carbon burning in massive stars. In determining the relative contribution of our s-only stellar yields to the solar abundances, we find it is important to take into account the neutron exposure of shell carbon burning. When we analyze our yields with a Salpeter Initial Mass Function, we find that massive stars contribute at least 40% to s-only nuclei with mass A 90, massive stars contribute on average ~7%, except for Gd152, Os187, and Hg198 which are ~14%, \~13%, and ~11%, respectively.Comment: 52 pages, 16 figures, accepted for publication in Ap

Calorimetric tunneling study of heat generation in metal-vacuum-metal tunnel junction

We have proposed novel calorimetric tunneling (CT) experiment allowing exact determination of heat generation (or heat sinking) in individual tunnel junction (TJ) electrodes which opens new possibilities in the field of design and development of experimental techniques for science and technology. Using such experiment we have studied the process of heat generation in normal-metal electrodes of the vacuum-barrier tunnel junction (VBTJ). The results show there exists dependence of the mutual redistribution of the heat on applied bias voltage and the direction of tunnel current, although the total heat generated in tunnel process is equal to Joule heat, as expected. Moreover, presented study indicates generated heat represents the energy of non-equilibrium quasiparticles coming from inelastic electron processes accompanying the process of elastic tunneling.Comment: 8 pages, 3 figures, LaTe

Enhanced Safety Surveillance of Influenza Vaccines in General Practice, Winter 2015-16: Feasibility Study

BACKGROUND: The European Medicines Agency (EMA) requires vaccine manufacturers to conduct enhanced real-time surveillance of seasonal influenza vaccination. The EMA has specified a list of adverse events of interest to be monitored. The EMA sets out 3 different ways to conduct such surveillance: (1) active surveillance, (2) enhanced passive surveillance, or (3) electronic health record data mining (EHR-DM). English general practice (GP) is a suitable setting to implement enhanced passive surveillance and EHR-DM. OBJECTIVE: This study aimed to test the feasibility of conducting enhanced passive surveillance in GP using the yellow card scheme (adverse events of interest reporting cards) to determine if it has any advantages over EHR-DM alone. METHODS: A total of 9 GPs in England participated, of which 3 tested the feasibility of enhanced passive surveillance and the other 6 EHR-DM alone. The 3 that tested EPS provided patients with yellow (adverse events) cards for patients to report any adverse events. Data were extracted from all 9 GPs' EHRs between weeks 35 and 49 (08/24/2015 to 12/06/2015), the main period of influenza vaccination. We conducted weekly analysis and end-of-study analyses. RESULTS: Our GPs were largely distributed across England with a registered population of 81,040. In the week 49 report, 15,863/81,040 people (19.57% of the registered practice population) were vaccinated. In the EPS practices, staff managed to hand out the cards to 61.25% (4150/6776) of the vaccinees, and of these cards, 1.98% (82/4150) were returned to the GP offices. Adverse events of interests were reported by 113 /7223 people (1.56%) in the enhanced passive surveillance practices, compared with 322/8640 people (3.73%) in the EHR-DM practices. CONCLUSIONS: Overall, we demonstrated that GPs EHR-DM was an appropriate method of enhanced surveillance. However, the use of yellow cards, in enhanced passive surveillance practices, did not enhance the collection of adverse events of interests as demonstrated in this study. Their return rate was poor, data entry from them was not straightforward, and there were issues with data reconciliation. We concluded that customized cards prespecifying the EMA's adverse events of interests, combined with EHR-DM, were needed to maximize data collection. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2016-015469

Untwisting of a Strained Cholesteric Elastomer by Disclination Loop Nucleation

The application of a sufficiently strong strain perpendicular to the pitch axis of a monodomain cholesteric elastomer unwinds the cholesteric helix. Previous theoretical analyses of this transition ignored the effects of Frank elasticity which we include here. We find that the strain needed to unwind the helix is reduced because of the Frank penalty and the cholesteric state becomes metastable above the transition. We consider in detail a previously proposed mechanism by which the topologically stable helical texture is removed in the metastable state, namely by the nucleation of twist disclination loops in the plane perpendicular to the pitch axis. We present an approximate calculation of the barrier energy for this nucleation process which neglects possible spatial variation of the strain fields in the elastomer, as well as a more accurate calculation based on a finite element modeling of the elastomer.Comment: 12 pages, 9 figure

Switching dynamics of surface stabilized ferroelectric liquid crystal cells: effects of anchoring energy asymmetry

We study both theoretically and experimentally switching dynamics in surface stabilized ferroelectric liquid crystal cells with asymmetric boundary conditions. In these cells the bounding surfaces are treated differently to produce asymmetry in their anchoring properties. Our electro-optic measurements of the switching voltage thresholds that are determined by the peaks of the reversal polarization current reveal the frequency dependent shift of the hysteresis loop. We examine the predictions of the uniform dynamical model with the anchoring energy taken into account. It is found that the asymmetry effects are dominated by the polar contribution to the anchoring energy. Frequency dependence of the voltage thresholds is studied by analyzing the properties of time-periodic solutions to the dynamical equation (cycles). For this purpose, we apply the method that uses the parameterized half-period mappings for the approximate model and relate the cycles to the fixed points of the composition of two half-period mappings. The cycles are found to be unstable and can only be formed when the driving frequency is lower than its critical value. The polar anchoring parameter is estimated by making a comparison between the results of modelling and the experimental data for the shift vs frequency curve. For a double-well potential considered as a deformation of the Rapini-Papoular potential, the branch of stable cycles emerges in the low frequency region separated by the gap from the high frequency interval for unstable cycles.Comment: 35 pages, 15 figure

Hydrodynamics of polar liquid crystals

Starting from a microscopic definition of an alignment vector proportional to the polarization, we discuss the hydrodynamics of polar liquid crystals with local $C_{\infty v}$-symmetry. The free energy for polar liquid crystals differs from that of nematic liquid crystals ($D_{\infty h}$) in that it contains terms violating the ${\bf{n}}\to -{\bf{n}}$ symmetry. First we show that these $\mathcal{Z}_2$-odd terms induce a general splay instability of a uniform polarized state in a range of parameters. Next we use the general Poisson-bracket formalism to derive the hydrodynamic equations of the system in the polarized state. The structure of the linear hydrodynamic modes confirms the existence of the splay instability.Comment: 9 pages, corrected typos, added references, revised content, to appear in PR

A machine learning pipeline for discriminant pathways identification

Motivation: Identifying the molecular pathways more prone to disruption during a pathological process is a key task in network medicine and, more in general, in systems biology. Results: In this work we propose a pipeline that couples a machine learning solution for molecular profiling with a recent network comparison method. The pipeline can identify changes occurring between specific sub-modules of networks built in a case-control biomarker study, discriminating key groups of genes whose interactions are modified by an underlying condition. The proposal is independent from the classification algorithm used. Three applications on genomewide data are presented regarding children susceptibility to air pollution and two neurodegenerative diseases: Parkinson's and Alzheimer's. Availability: Details about the software used for the experiments discussed in this paper are provided in the Appendix