Update of transmission modelling and projections of gambiense human African trypanosomiasis in the Mandoul focus, Chad

In recent years, a programme of vector control, screening and treatment of gambiense human African trypanosomiasis (gHAT) infections led to a rapid decline in cases in the Mandoul focus of Chad. To represent the biology of transmission between humans and tsetse, we previously developed a mechanistic transmission model, fitted to data between 2000 and 2013 which suggested that transmission was interrupted by 2015. The present study outlines refinements to the model to: (1) Assess whether elimination of transmission has already been achieved despite low-level case reporting; (2) quantify the role of intensified interventions in transmission reduction; and (3) predict the trajectory of gHAT in Mandoul for the next decade under different strategies. Method Our previous gHAT transmission model for Mandoul was updated using human case data (2000–2019) and a series of model refinements. These include how diagnostic specificity is incorporated into the model and improvements to the fitting method (increased variance in observed case reporting and how underreporting and improvements to passive screening are captured). A side-by-side comparison of fitting to case data was performed between the models. Results We estimated that passive detection rates have increased due to improvements in diagnostic availability in fixed health facilities since 2015, by 2.1-fold for stage 1 detection, and 1.5-fold for stage 2. We find that whilst the diagnostic algorithm for active screening is estimated to be highly specific (95% credible interval (CI) 99.9–100%, Specificity = 99.9%), the high screening and low infection levels mean that some recently reported cases with no parasitological confirmation might be false positives. We also find that the focus-wide tsetse reduction estimated through model fitting (95% CI 96.1–99.6%, Reduction = 99.1%) is comparable to the reduction previously measured by the decline in tsetse catches from monitoring traps. In line with previous results, the model suggests that transmission was interrupted in 2015 due to intensified interventions. Conclusions We recommend that additional confirmatory testing is performed in Mandoul to ensure the endgame can be carefully monitored. More specific measurement of cases, would better inform when it is safe to stop active screening and vector control, provided there is a strong passive surveillance system in place

Health economic evaluation of strategies to eliminate gambiense human African trypanosomiasis in the Mandoul disease focus of Chad

Human African trypanosomiasis, caused by the gambiense subspecies of Trypanosoma brucei (gHAT), is a deadly parasitic disease transmitted by tsetse. Partners worldwide have stepped up efforts to eliminate the disease, and the Chadian government has focused on the previously high-prevalence setting of Mandoul. In this study, we evaluate the economic efficiency of the intensified strategy that was put in place in 2014 aimed at interrupting the transmission of gHAT, and we make recommendations on the best way forward based on both epidemiological projections and cost-effectiveness. In our analysis, we use a dynamic transmission model fit to epidemiological data from Mandoul to evaluate the cost-effectiveness of combinations of active screening, improved passive screening (defined as an expansion of the number of health posts capable of screening for gHAT), and vector control activities (the deployment of Tiny Targets to control the tsetse vector). For cost-effectiveness analyses, our primary outcome is disease burden, denominated in disability-adjusted life-years (DALYs), and costs, denominated in 2020 US$. Although active and passive screening have enabled more rapid diagnosis and accessible treatment in Mandoul, the addition of vector control provided good value-for-money (at less than$750/DALY averted) which substantially increased the probability of reaching the 2030 elimination target for gHAT as set by the World Health Organization. Our transmission modelling and economic evaluation suggest that the gains that have been made could be maintained by passive screening. Our analysis speaks to comparative efficiency, and it does not take into account all possible considerations; for instance, any cessation of ongoing active screening should first consider that substantial surveillance activities will be critical to verify the elimination of transmission and to protect against the possible importation of infection from neighbouring endemic foci

PSR J1024-0719:A Millisecond Pulsar in an Unusual Long-Period Orbit

PSR J1024-0719 is a millisecond pulsar that was long thought to be isolated. However, puzzling results concerning its velocity, distance, and low rotational period derivative have led to a reexamination of its properties. We present updated radio timing observations along with new and archival optical data which show that PSR J1024-0719 is most likely in a long-period (2-20 kyr) binary system with a low-mass (approximate to 0.4 M-circle dot), low-metallicity (Z approximate to -0.9 dex) main-sequence star. Such a system can explain most of the anomalous properties of this pulsar. We suggest that this system formed through a dynamical exchange in a globular cluster that ejected it into a halo orbit, which is consistent with the low observed metallicity for the stellar companion. Further astrometric and radio timing observations such as measurement of the third period derivative could strongly constrain the range of orbital parameters

THE APOGEE SPECTROSCOPIC SURVEY OF KEPLER PLANET HOSTS: FEASIBILITY, EFFICIENCY, AND FIRST RESULTS

The Kepler mission has yielded a large number of planet candidates from among the Kepler Objects of Interest(KOIs), but spectroscopic follow-up of these relatively faint stars is a serious bottleneck in confirming and characterizing these systems. We present motivation and survey design for an ongoing project with the Sloan Digital Sky Survey III multiplexed Apache Point Observatory Galactic Evolution Experiment (APOGEE) near-infrared spectrograph to monitor hundreds of KOI host stars. We report some of our first results using representative targets from our sample, which include current planet candidates that we find to be false positives, as well as candidates listed as false positives that we do not find to be spectroscopic binaries. With this survey, KOI hosts are observed over ∼20 epochs at a radial velocity (RV) precision of 100–200ms−1. These observations can easily identify a majority of false positives caused by physically associated stellar or substellar binaries, and in many cases, fully characterize their orbits. We demonstrate that APOGEE is capable of achieving RV precision at the 100–200ms−1 level over long time baselines, and that APOGEE’s multiplexing capability makes it substantially more efficient at identifying false positives due to binaries than other single-object spectrographs working to confirm KOIs as planets. These APOGEE RVs enable ancillary science projects, such as studies of fundamental stellar astrophysics or intrinsically rare substellar companions. The coadded APOGEE spectra can be used to derive stellar properties (Teff, log g) and chemical abundances of over a dozen elements to probe correlations of planet properties with individual elemental abundances

The development, validation and analysis of new endosurgical procedures in upper gastrointestinal surgery / by Justin Raymond Bessell

Bibliography: leaves 197-220.xv, 220 leavesAnalyses some general problems of laparoscopy, particularly in relation to induced physiological disturbances; by development and evaluation of new applications in laparoscopic gastrointestinal surgery ; and by assessing the efficacy of laparoscopic procedures which have already entered rountine practice.Thesis (M.D.) -- University of Adelaide, Dept. of Surgery, 1996

Is gastric banding appropriate in Indigenous or remote-dwelling persons?

Gastric banding has been promoted as less suitable for indigenous persons or persons who live remotely as it requires in person follow-up for band adjustment and may have higher rates of reoperation. This study assessed being an indigenous Australian or living remotely (but not both) on outcomes following gastric banding.Data was prospectively recorded on all 559 patients who underwent gastric banding by one surgeon at one private hospital in Darwin, between February 1998 and August 2014.Forty persons (7 %) were indigenous and 93 (17 %) were remotely living (only 7 were both). At the last assessment (follow-up 37 (SD 31) months), overall percentage of excess weight loss (EWL) was 53 % (30 %), the percentage of total weight loss (TWL) was 23 (13), and 389 (70 %) achieved > 50 % EWL. Seventy-two percent (43/60) ceased all diabetic medications. Ninety-two (17 %) came to reoperation. There was little difference between the indigenous and non-indigenous metropolitan-living groups, or between the remote and metropolitan non-indigenous groups in %EWL, %TWL, the proportion who achieved more than 50 % EWL, the time to achieve the goal weight, or cessation of diabetes medication. Similarly, there was little difference in the time to band removal or replacement. No person was directly compromised at band removal/replacement by delay due to dwelling remotely.In these select persons who underwent gastric banding in the private sector only, outcomes of weight loss and revisional surgery were acceptable and comparable between indigenous and non-indigenous metropolitan-dwelling persons as well as between remote and metropolitan-dwelling non-indigenous persons

Acute ruptured esophageal duplication cyst

Eu Ling Neo, David I. Watson, Justin R. Bessel