Community-based DOTS and family member DOTS for TB control in Nepal: costs and cost-effectiveness

<p>Abstract</p> <p>Background</p> <p>Two TB control strategies appropriate for South Asia (a community-based DOTS [CBD] strategy and a family-based DOTS [FBD] strategy) have been shown to be effective in Nepal in meeting the global target for the proportion of registered patients successfully treated. Here we estimate the costs and cost-effectiveness of the two strategies. This information is essential to allow meaningful comparisons between these and other strategies and will contribute to the small but growing body of knowledge on the costs and cost-effectiveness of different approaches to TB control.</p> <p>Methods</p> <p>In 2001–2, costs relating to TB diagnosis and care were collected for each strategy. Structured and semi-structured questionnaires were used to collect costs from health facility records and a sample of 10 patients in each of 10 districts, 3 using CBD and 2 using FBD. The data collected included costs to the health care system and social costs (including opportunity costs) incurred by patients and their supervisors. The cost-effectiveness of each strategy was estimated.</p> <p>Results</p> <p>Total recurrent costs per patient using the CBD and FBD strategies were US$76.2 and US$84.1 respectively. The social costs incurred by patients and their supervisors represent more than a third of total recurrent costs under each strategy (37% and 35% respectively). The CBD strategy was more cost-effective than the FBD strategy: recurrent costs per successful treatment were US$91.8 and US$102.2 respectively.</p> <p>Discussion</p> <p>Although the CBD strategy was more cost-effective than the FBD strategy in the study context, the estimates of cost-effectiveness were sensitive to relatively small changes in underlying costs and treatment outcomes. Even using these relatively patient-friendly approaches to DOTS, social costs can represent a significant financial burden for TB patients.</p

Hydration of calcium [alumino] ferrite with limestone

Ferrite has the lowest embodied CO2 among the four major phases found in Portland cement, so increasing the ferrite content of the clinker would improve its CO2 footprint. Ferrite hydration is known to depend on the cooling regime during the production, Al/Fe ratio, and minor element uptake, and thus, their effects have to be fully understood to increase the composition of this phase in the Portland cement and assure their good hydration properties. Here, ferrites with different Al/Fe ratios (0, 0.5, 1, and 2), and minor elements (Zn) has been synthesized at two different burning temperatures, 1250 °C and 1350 °C and hydrated in presence of excess CaCO3 for 1 and 3 days. The ferrite with Al/Fe = 0 did not form any hydration product after 3 days of hydration, while Al-monocarbonate was the only hydration product in the other systems. The hydration kinetics increased with Al/Fe ratio, and when the burning temperature was increased. Comparing XRD and TGA data, the Al-monocarbonate formed from the ferrite with Al/Fe = 2 was found to be more amorphous than other ferrites. ZnO doping up to 2 wt.% had no prominent effect on hydration, implying that raw materials with Zn can be utilised in high-ferrite cement. These results indicate that high-ferrite limestone cement could be a promising solution to reduce cement the CO2 emission

Effect of synthesis conditions, Zn doping and Al/Fe ratio on calcium [alumino] ferrite structure

The use of steel waste for clinker production is a promising solution to reduce the environmental impact of Portland cement. While it is known that clinker produced from steel slag shows some advantageous properties e.g., lower burning temperature and reduced use of limestone, it is necessary to understand the formation and stability of iron-rich clinkers doped with the minor elements commonly found in steel wastes. In this study, pure ferrite phases were synthesized with varying Al/Fe ratios, burning temperature, cooling regimes, and in the presence of Zn as a minor element at various dosages. The phase assemblage and microstructure of the obtained ferrites were characterised by XRD/Rietveld and BSE-SEM/EDX. The results show that Zn is partially incorporated into the ferrite structure and partially replaces Al to form a Ca-Al-Zn phase. The Zn-incorporated ferrite leads to increased lattice parameter due to the bigger ionic radius of the dopant with respect to the substituted ions, and to increased crystallinity due to the increased ion mobility brought by ZnO which acts like a flux

Development of a Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant Tuberculosis (MDR-TB) Care in Nepal

Multi-drug-resistant tuberculosis (MDR-TB) poses a major threat to public health worldwide, particularly in low-income countries. The current long (20 month) and arduous treatment regime uses powerful drugs with side-effects that include mental ill-health. It has a high loss-to-follow-up (25%) and higher case fatality and lower cure-rates than those with drug sensitive tuberculosis (TB). While some national TB programmes provide small financial allowances to patients, other aspects of psychosocial ill-health, including iatrogenic ones, are not routinely assessed or addressed. We aimed to develop an intervention to improve psycho-social well-being for MDR-TB patients in Nepal. To do this we conducted qualitative work with MDR-TB patients, health professionals and the National TB programme (NTP) in Nepal. We conducted semi-structured interviews (SSIs) with 15 patients (10 men and 5 women, aged 21 to 68), four family members and three frontline health workers. In addition, three focus groups were held with MDR-TB patients and three with their family members. We conducted a series of meetings and workshops with key stakeholders to design the intervention, working closely with the NTP to enable government ownership. Our findings highlight the negative impacts of MDR-TB treatment on mental health, with greater impacts felt among those with limited social and financial support, predominantly married women. Michie et al's (2011) framework for behaviour change proved helpful in identifying corresponding practice- and policy-level changes. The findings from this study emphasise the need for tailored psycho-social support. Recent work on simple psychological support packages for the general population can usefully be adapted for use with people with MDR-TB

Measurement of charged jet cross section in pp collisions at s =5.02 TeV

The cross section of jets reconstructed from charged particles is measured in the transverse momentum range of

Measurement of electrons from heavy-flavour hadron decays as a function of multiplicity in p-Pb collisions at √sNN = 5.02 TeV

The multiplicity dependence of electron production from heavy-flavour hadron decays as a function of transverse momentum was measured in p-Pb collisions at sNN = 5.02 TeV using the ALICE detector at the LHC. The measurement was performed in the centre-of-mass rapidity interval −1.07 &lt; ycms&lt; 0.14 and transverse momentum interval 2 &lt; pT&lt; 16 GeV/c. The multiplicity dependence of the production of electrons from heavy-flavour hadron decays was studied by comparing the pT spectra measured for different multiplicity classes with those measured in pp collisions (QpPb) and in peripheral p-Pb collisions (Qcp). The QpPb results obtained are consistent with unity within uncertainties in the measured pT interval and event classes. This indicates that heavy-flavour decay electron production is consistent with binary scaling and independent of the geometry of the collision system. Additionally, the results suggest that cold nuclear matter effects are negligible within uncertainties, in the production of heavy-flavour decay electrons at midrapidity in p-Pb collisions. [Figure not available: see fulltext.

Measurement of Λ (1520) production in pp collisions at √s=7TeV and p–Pb collisions at √sNN=5.02TeV

The production of the Λ (1520) baryonic resonance has been measured at midrapidity in inelastic pp collisions at s=7TeV and in p–Pb collisions at sNN=5.02TeV for non-single diffractive events and in multiplicity classes. The resonance is reconstructed through its hadronic decay channel Λ (1520) → pK - and the charge conjugate with the ALICE detector. The integrated yields and mean transverse momenta are calculated from the measured transverse momentum distributions in pp and p–Pb collisions. The mean transverse momenta follow mass ordering as previously observed for other hyperons in the same collision systems. A Blast-Wave function constrained by other light hadrons (π, K, KS0, p, Λ) describes the shape of the Λ (1520) transverse momentum distribution up to 3.5GeV/c in p–Pb collisions. In the framework of this model, this observation suggests that the Λ (1520) resonance participates in the same collective radial flow as other light hadrons. The ratio of the yield of Λ (1520) to the yield of the ground state particle Λ remains constant as a function of charged-particle multiplicity, suggesting that there is no net effect of the hadronic phase in p–Pb collisions on the Λ (1520) yield

Inclusive J/ψ production at mid-rapidity in pp collisions at √s = 5.02 TeV

Inclusive J/ψ production is studied in minimum-bias proton-proton collisions at a centre-of-mass energy of s = 5.02 TeV by ALICE at the CERN LHC. The measurement is performed at mid-rapidity (|y| &lt; 0.9) in the dielectron decay channel down to zero transverse momentum pT, using a data sample corresponding to an integrated luminosity of Lint = 19.4 ± 0.4 nb−1. The measured pT-integrated inclusive J/ψ production cross sec- tion is dσ/dy = 5.64 ± 0.22(stat.) ± 0.33(syst.) ± 0.12(lumi.) μb. The pT-differential cross section d2σ/dpTdy is measured in the pT range 0–10 GeV/c and compared with state-of- the-art QCD calculations. The J/ψ 〈pT〉 and 〈pT2〉 are extracted and compared with results obtained at other collision energies. [Figure not available: see fulltext.]