755 research outputs found

    Epidemiological Modeling of Bovine Brucellosis in India.

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    The study objective is to develop an epidemiological model of brucellosis transmission dynamics among cattle in India and to estimate the impact of different prevention and control strategies. The prevention and control strategies are test-and-slaughter, transmission rate reduction, and mass vaccination. We developed a mathematical model based on the susceptible-infectious-recovered epidemic model to simulate brucellosis transmission dynamics, calibrated to the endemically stable levels of bovine brucellosis prevalence of cattle in India. We analyzed the epidemiological benefit of different rates of reduced transmission and vaccination. Test-and-slaughter is an effective strategy for elimination and eradication of brucellosis, but socio-cultural constraints forbid culling of cattle in India. Reducing transmission rates lowered the endemically stable levels of brucellosis prevalence correspondingly. One-time vaccination lowered prevalence initially but increased with influx of new susceptible births. While this epidemiological model is a basic representation of brucellosis transmission dynamics in India and constrained by limitations in surveillance data, this study illustrates the comparative epidemiological impact of different bovine brucellosis prevention and control strategies

    Initiating haemodialysis twice-weekly as part of an incremental programme may protect residual kidney function

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    © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.Background: Initiating twice-weekly haemodialysis (2×HD) in patients who retain significant residual kidney function (RKF) may have benefits. We aimed to determine differences between patients initiated on twice- and thrice-weekly regimes, with respect to loss of kidney function, survival and other safety parameters. Methods: We conducted a single-centre retrospective study of patients initiating dialysis with a residual urea clearance (KRU) of ≥3 mL/min, over a 20-year period. Patients who had 2×HD for ≥3 months during the 12 months following initiation of 2×HD were identified for comparison with those dialysed thrice-weekly (3×HD). Results: The 2×HD group consisted of 154 patients, and the 3×HD group 411 patients. The 2×HD patients were younger (59 ± 15 versus 62 ± 15 years: P = 0.014) and weighed less (70 ± 16 versus 80 ± 18 kg: P < 0.001). More were females (34% versus 27%: P = 0.004). Fewer had diabetes (25% versus 34%: P = 0.04) and peripheral vascular disease (PVD) (13% versus 23%: P = 0.008). Baseline KRU was similar in both groups (5.3 ± 2.4 for 2 × HD versus 5.1 ± 2.8 mL/min for 3 × HD: P = 0.507). In a mixed effects model correcting for between-group differences in comorbidities and demographics, 3×HD was associated with increased rate of loss of KRU and separation of KRU. In separate mixed effects models, group (2×HD versus 3×HD) was not associated with differences in serum potassium or phosphate, and the groups did not differ with respect to total standard Kt/V. Survival, adjusted for age, gender, weight, baseline KRU and comorbidity (prevalence of diabetes, cardiac disease, PVD and malignancy) was greater in the 2×HD group (hazard ratio 0.755: P = 0.044). In sub-analyses, the survival benefit was confined to women, and those of less than median bodyweight. Conclusion: 2×HD initiation as part of an incremental programme with regular monthly monitoring of KRU was safe and associated with a reduced rate of loss of RKF early after dialysis initiation and improved survival. Randomized controlled trials of this approach are indicated.Peer reviewedFinal Accepted Versio

    The iconography of Asphyxiophilia: From fantasmatic fetish to forensic fact

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    This is a post print version of the article. The official published version can be accessed from the link below

    Challenges for social media: Misinformation, free speech, civic engagement, and data regulations

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    Social media has arguably brought one of the greatest changes to Internet communication since the invention of the Web but challenges as well. Apart from helping people to have access and to exchange information, social media has also been used to spread misinformation, hate speech, and the user‐generated data is adopted for targeted commercial and political advertising based on personal profiles. Moreover, the most popular applications available are owned by a small number of companies who may have an undue influence on how civic engagement takes place on their platforms. In this panel, four panelists will discuss the following: misinformation and the role of pseudo‐cognitive authorities; hate speech and Germany’s Network Enforcement Act (NetzGD); civic engagement and market capture by social media companies; and finally, personal data processing and the General Data Protection Regulation (GDPR). We intend to raise interesting questions helping to understand these issues, and to find solutions for the beneficial use of information technologies as well as to scope out all its advantages.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147854/1/pra214505501076.pd

    Epidemiological Effectiveness and Cost of a Fungal Meningitis Outbreak Response in New River Valley, Virginia: Local Health Department and Clinical Perspectives.

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    OBJECTIVE: We evaluated the effectiveness and cost of a fungal meningitis outbreak response in the New River Valley of Virginia during 2012-2013 from the perspective of the local public health department and clinical facilities. The fungal meningitis outbreak affected 23 states in the United States with 751 cases and 64 deaths in 20 states; there were 56 cases and 5 deaths in Virginia. METHODS: We conducted a partial economic evaluation of the fungal meningitis outbreak response in New River Valley. We collected costs associated with the local health department and clinical facilities in the outbreak response and estimated the epidemiological effectiveness by using disability-adjusted life years (DALYs) averted. RESULTS: We estimated the epidemiological effectiveness of this outbreak response to be 153 DALYs averted among the patients, and the costs incurred by the local health department and clinical facilities to be 30,413and30,413 and 39,580, respectively. CONCLUSIONS: We estimated the incremental cost-effectiveness ratio of 198perDALYavertedand198 per DALY averted and 258 per DALY averted from the local health department and clinical perspectives, respectively, thereby assisting in impact evaluation of the outbreak response by the local health department and clinical facilities. (Disaster Med Public Health Preparedness. 2018;12:38-46)

    Economic Evaluation of Fungal Meningitis Outbreak Response in New River Valley: Local Health Department Perspective

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    Background: The multi-state fungal meningitis outbreak started in September 2012 in Tennessee. The cause of the outbreak was injection of contaminated lots of methylprednisolone acetate used in epidural spinal injections. Roanoke and New River Valley were the epicenter of this outbreak in Virginia, with two clinical centers having administered the contaminated injections to their patients. New River Health District, in coordination with hospitals, and state and federal agencies, deployed its resources to control the local impact of the outbreak. Purpose: The objective of this study was to conduct an economic evaluation of the fungal meningitis outbreak response in New River Valley of Virginia, from the local public health department perspective. Methods: The health department conducted the outbreak investigation from October 2012 until March 2013 to ascertain that all possible cases were identified and treated. Data were collected on the costs associated with the local health department in the outbreak response, and the epidemiologic effectiveness estimated, using the metric of disability adjusted life years (DALYs). Results: The cost incurred by the local health department was estimated to be 30,493;theepidemiologiceffectivenesswasestimatedtobe138DALYsavertedamongthepatients,foranincrementalcosteffectivenessratioof30,493; the epidemiologic effectiveness was estimated to be 138 DALYs averted among the patients, for an incremental cost-effectiveness ratio of 221 per DALY averted. Implications: The incremental cost effectiveness ratio of the fungal meningitis outbreak response in New River Valley assists the local health department to analyze the costs and epidemiologic effectiveness of the outbreak response
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