The Cost Effectiveness of Mental Health Treatment in the Lifetime of Older Adults with HIV in New York City: A Markov Approach

Background There are noticeable gaps in knowledge regarding the cost and effectiveness of integrated medical and behavioral services for older adults with HIV. Their lifespan is close to the population’s level but their quality of life has sharply declined due to depression and substance use. Mental health disorders are widespread among an aging population with HIV. Objective The aim of this study was to build a decision analytic model to evaluate medical interventions with and without mental health treatment using primary data of 139 older adults with HIV and health outcomes from the literature. Methods We tracked the progression of depression and cumulative deaths among older adults with HIV using a Markov model with 50 annual cycles through three health states. Deterministic and probabilistic sensitivity analyses addressed uncertainty in estimating the parameters and around the model’s assumptions. Results An integrated medical and behavioral care system is cost effective at a willingness to pay of $50,000 per QALY compared with medical care only. The incremental cost was$516,452 and the incremental effectiveness was 38.8 quality-adjusted life-years (QALY), with an incremental cost-effectiveness ratio of $13,316 per QALY. Conclusions Appropriate and efficacious referrals to integrated medical + behavioral services, either in the same facility or connected to their primary care doctor, are instrumental to reverse loses in quality of life and avoid premature death. If mental health is left unattended, HIV would progress, causing declines in quality of life and ultimately triggering premature death. Reliable data on the cost and effectiveness of different types of HIV integrated services are needed

Associations between olfactory pathway gene methylation marks, obesity features and dietary intakes

Abstract Background Olfaction is an important sense influencing food preferences, appetite, and eating behaviors. This hypothesis-driven study aimed to assess associations between olfactory pathway gene methylation signatures, obesity features, and dietary intakes. Methods A nutriepigenomic analysis was conducted in 474 adults from the Methyl Epigenome Network Association (MENA) project. Anthropometric measurements, clinical data, and serum metabolic profiles of the study population were obtained from structured databases of the MENA cohorts. Habitual dietary intake was assessed using a validated semiquantitative food frequency questionnaire. DNA methylation was measured in circulating white blood cells by microarray (Infinium Human Methylation 450 K BeadChips). FDR values (p < 0.0001) were used to select those CpGs that showed the best correlation with body mass index (BMI) and waist circumference (WC). Pathway analyses involving the characterization of genes involved in the olfactory transduction system were performed using KEGG and pathDIP reference databases. Results Overall, 15 CpG sites at olfactory pathway genes were associated with BMI (p < 0.0001) and WC (p < 0.0001) after adjustments for potential confounding factors. Together, methylation levels at the15 CpG sites accounted for 22% and 20% of the variability in BMI and WC (r 2 = 0.219, p < 0.001, and r 2 = 0.204, p < 0.001, respectively). These genes encompassed olfactory receptors (OR4D2, OR51A7, OR2T34, and OR2Y1) and several downstream signaling molecules (SLC8A1, ANO2, PDE2A, CALML3, GNG7, CALML6, PRKG1, and CAMK2D), which significantly regulated odor detection and signal transduction processes within the complete olfactory cascade, as revealed by pathway enrichment analyses (p = 1.94 × 10–10). Moreover, OR4D2 and OR2Y1 gene methylation patterns strongly correlated with daily intakes of total energy (p < 0.0001), carbohydrates (p < 0.0001), protein (p < 0.0001), and fat (p < 0.0001). Conclusions The results of this study suggest novel relationships between olfactory pathway gene methylation signatures, obesity indices, and dietary intakes

Effects of Leucine Administration in Sarcopenia:A Randomized and Placebo-controlled Clinical Trial

Treating sarcopenia in older individuals remains a challenge, and nutritional interventions present promising approaches in individuals that perform limited physical exercise. We assessed the efficacy of leucine administration to evaluate whether the regular intake of this essential amino acid can improve muscle mass, muscle strength and functional performance and respiratory muscle function in institutionalized older individuals. The study was a placebo-controlled, randomized, double-blind design in fifty participants aged 65 and over (ClinicalTrials.gov identifier NCT03831399). The participants were randomized to a parallel group intervention of 13 weeks' duration with a daily intake of leucine (6 g/day) or placebo (lactose, 6 g/day). The primary outcome was to study the effect on sarcopenia and respiratory muscle function. The secondary outcomes were changes in the geriatric evaluation scales, such as cognitive function, functional impairment and nutritional assessments. We also evaluated whether leucine administration alters blood analytical parameters and inflammatory markers. Administration of leucine was well-tolerated and significantly improves some criteria of sarcopenia in elderly individuals such as functional performance measured by walking time (p = 0.011), and improved lean mass index. For respiratory muscle function, the leucine-treated group improved significantly (p = 0.026) in maximum static expiratory force compared to the placebo. No significant effects on functional impairment, cognitive function or nutritional assessment, inflammatory cytokines IL-6, TNF-alpha were observed after leucine administration compared to the placebo. The use of l-leucine supplementation can have some beneficial effects on sarcopenia and could be considered for the treatment of sarcopenia in older individuals

Evaluation of the Effects of Powder Coating Cure Temperatures on the Mechanical Properties of Aluminum Alloy Substrates

The effects of curing temperature, based on new, low-temperature powder coating methods and traditional high-temperature powder coating methods, were studied. Heat-sensitive aluminum alloys (2024-T3, 6061-T6, and 7075-T6) were subjected to two different heat-treatment cycles, which were based on temperatures of 121 and 204 degrees C. Findings indicate that although both cure temperatures achieved powder coatings adhesion and thickness appropriate for industrial uses, the high-temperature cure treatment negatively affected the mechanical properties

Marketing strategy of the hospitality industry

Budući da se gospodarstvo sve više razvija u smjeru uslužnih djelatnosti, nameće se potreba da marketing manageri, marketing stručnjaci i poduzetnici, što bolje upoznaju uslužne djelatnosti i njihovu važnost za gospodarstvo svake zemlje, pa i Hrvatske. Usluge su neopipljive, nedjeljive, nepostojane i prolazne, pa svaki oblik usluga zahtijeva marketing strategiju. Naime, gospodarska uslužna djelatnost omogućava proizvodnji da premosti prostor ili segmente tržišta između proizvodnje i potrošnje, kako bi se u određenom vremenu i prostoru učinkovito zadovoljile potrebe potrošača i ostvarili ciljevi poduzeća, uz planiranu dobit ili profit. U prošlosti, uslužne djelatnosti su znatno zaostajale za proizvodnim poduzećima u usvajanju i primjeni marketing koncepcije, no sada se to znatno mijenja. Sukladno s iznesenim, marketing strategija u uslužnim djelatnostima zahtijeva ne samo vanjski marketing, već i marketing unutar poduzeća, kako bi se motivirali djelatnici u pružanju usluga i podizanju razine kvalitete.Considering the current growth of the hospitality industry, the marketing managers, experts and entrepreneurs should become aware of the growing importance of various hospitality services for the overall industry of each country including the Republic of Croatia. The services rendered in the hospitality sphere are intangible and unsteady in nature so that each domain necessarily requires a separate marketing strategy. Namely, hospitality services render it possible for the production to span the space, i.e. the different market segments between the supply and demand and meet the consumers needs as well as to achieve the set objectives. In the past years the hospitality industry was considerably falling behind other business enterprises and organizations in the adoption and application of appropriate marketing concepts. It seems, however, that the situation has turned for the better. The hospitality services clearly demand not only an exterior marketing strategy but also a proper marketing technique inside individual establishments in order to achieve a higher level of motivation among the hospitality staff as well as a better quality of service

Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism : A systematic review by the EAU Sexual and Reproductive Health Guidelines panel

Peer reviewedPostprin

The effectiveness of sewage treatment processes to remove faecal pathogens and antibiotic residues

Pathogens and antibiotics enter the aquatic environment via sewage effluents and may pose a health risk to wild life and humans. The aim of this study was to determine the levels of faecal bacteria, and selected antibiotic residues in raw wastewater and treated sewage effluents from three different sewage treatment plants in the Western Cape, South Africa. Sewage treatment plant 1 and 2 use older technologies, while sewage treatment plant 3 has been upgraded and membrane technologies were incorporated in the treatment processes. Coliforms and Escherichia coli (E. coli) were used as bioindicators for faecal bacteria. A chromogenic test was used to screen for coliforms and E. coli. Fluoroquinolones and sulfamethoxazole are commonly used antibiotics and were selected to monitor the efficiency of sewage treatment processes for antibiotic removal. Enzyme Linked Immunosorbent Assays (ELISAs) were used to quantitate antibiotic residues in raw and treated sewage. Raw intake water at all treatment plants contained total coliforms and E. coli. High removal of E. coli by treatment processes was evident for treatment plant 2 and 3 only. Fluoroquinolones and sulfamethoxazole were detected in raw wastewater from all sewage treatment plants. Treatment processes at plant 1 did not reduce the fluoroquinolone concentration in treated sewage effluents. Treatment processes at plant 2 and 3 reduced the fluoroquinolone concentration by 21% and 31%, respectively. Treatment processes at plant 1 did not reduce the sulfamethoxazole concentration in treated sewage effluents. Treatment processes at plant 2 and 3 reduced sulfamethoxazole by 34% and 56%, respectively. This study showed that bacteria and antibiotic residues are still discharged into the environment. Further research needs to be undertaken to improve sewage treatment technologies, thereby producing a better quality treated sewage effluent

What is the effectiveness of surgical and non-surgical therapies in the treatment of ischemic priapism in patients with sickle cell disease? A systematic review by the EAU Sexual and Reproductive Health Panel

The authors acknowledge the participants for their cooperation Conflict of Interest: None of the authors declare any interest. Formatting of funding sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Peer reviewedPostprin

Use of water-Cherenkov detectors to detect Gamma-Ray-Bursts at the Large Aperture GRB Observatory (LAGO)

The Large Aperture GRB Observatory (LAGO) project aims at the detection of high energy photons from Gamma Ray Bursts (GRB) using the single particle technique in ground-based water-Cherenkov detectors (WCD). To reach a reasonable sensitivity, high altitude mountain sites have been selected in Mexico (Sierra Negra, 4550 m a.s.l.), Bolivia (Chacaltaya, 5300 m a.s.l.) and Venezuela (Me´ rida, 4765 m a.s.l.). We report on detector calibration and operation at high altitude, search for bursts in 4 months of preliminary data, as well as search for signal at ground level when satellites report a burst.Fil: Allard, D.. Université Paris Diderot - Paris 7; FranciaFil: Allekotte, Ingomar. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Alvarez, C.. Facultad de Ciencias Fısico-Matematicas; MéxicoFil: Asorey, Hernán Gonzalo. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Barros, H.. Universidad Simon Bolivar; VenezuelaFil: Bertou, Xavier Pierre Louis. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Burgoa, O.. Instituto de Investigaciones Fisicas; BoliviaFil: Gomez Berisso, Mariano. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Martinez, O.. Facultad de Ciencias Fısico-Matematicas; MéxicoFil: Miranda Loza, P.. Instituto de Investigaciones Fısicas; BoliviaFil: Murrieta, T.. Facultad de Ciencias Fısico-Matematicas; MéxicoFil: Perez, G.. Facultad de Ciencias Fısico-Matematicas; MéxicoFil: Rivera, H.. Instituto de Investigaciones Fısicas; BoliviaFil: Rovero, Adrian Carlos. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Saavedra, O.. Istituto Nazionale di Fisica Nucleare; ItaliaFil: Salazar, H.. Facultad de Ciencias Fısico-Matematicas ; MéxicoFil: Tello, J. C.. Universidad Simon Bolıvar; VenezuelaFil: Ticona Peralda, R.. Instituto de Investigaciones Fısicas; BoliviaFil: Velarde, A.. Instituto de Investigaciones Fısicas; BoliviaFil: Villaseñor, L.. Universidad de Michoacan; MéxicoFil: Areso, Omar Antonio. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Arnaldi, Luis Horacio. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Dasso, Sergio Ricardo. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Gonzalez, M.. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Gulisano, Adriana Maria. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Martin, R.. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; ArgentinaFil: Masías Meza, Jimmy Joel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Física de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Física de Buenos Aires; ArgentinaFil: Sidelnik, Iván Pedro. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Alvarez, W.. Universidad de San Carlos; GuatemalaFil: The LAGO Collaboration