Potential Cost Savings of Not Doing CD4 Counts in HIV Positive People In Rhode Island With An Undetectable Viral Load

CD4 cells fight infections in the body. When someone contacts Human Immunodeficiency Virus (HIV), their CD4 cells are taken over by HIV which turns them into manufacturers of many copies of the virus. The Viral Load (VL) measures the amount of virus in the blood. When HIV takes over the CD4 cells, the VL increases while the number of necessary CD4 cells decreases. When patients maintain stable treatment, their CD4 counts rise, and VLs may become undetectable, indicating the virus is too little to be detected in their blood. Knowing this, is frequent CD4 counts necessary for those with undetectable viral loads? We hypothesized that a lot of money can be saved by not performing CD4 counts in HIV patients that have undetectable VLs. In Rhode Island, of the 2,000-3,000 people with HIV/AIDS, 1,500-2,000 are being treated. About 69% (average: 1,208) have undetectable VLs. Health organizations recommend CD4 counts be administered every 3-6 months. With the cost of CD4 tests averaging $53, the frequency of testing can be costly. If undetectable patients get tested quarterly, the average cost would be$256,096. If tested every 6 months, the average cost would be $128,048. Based on these calculations, if these tests were eliminated, Rhode Island could save substantial amounts of money over time. Eliminating tests for undetectable patients (abiding by the recommended 6 month checkup) would save an average of$128,048 annually, an average of $640,240 over 5 years, and an average of$1,280,480 over 10 years

Funktionelle Untersuchungen an Trophoblastzellkulturen zur Prophylaxe und Therapie der Präeklampsie: eine in vitro Studie

Ziel dieser In-vitro-Studie war es, den Einfluss von (+-)-Nikotin, Acetylsalicylsäure (ASS) und Triamcinolon auf humane Trophoblastzellen und den Präeklampsiemarker lösliche fms-ähnliche Tyrosinkinase (sFlt-1) zu untersuchen. Die Arbeit konnte bestätigen, dass Nikotin Einfluss auf die Expression des sFlt-1 in In-vitro-Trophoblastzellkulturen nehmen kann. ASS zeigte weder einen Einfluss auf sFlt-1 noch konnte eine Beinträchtigung der Trophoblastzellfunktion gemessen werden. Triamcinolongabe reduzierte die sFlt-1-Spiegel ebenfalls nicht und resultierte in einer verrignerten Zellaktivität

Verbesserung der Euter- und Stoffwechselgesundheit in der ökologischen Milchviehhaltung durch interdisziplinär entwickelte betriebsindividuelle Interventionsmaßnahmen Interventionsstudie in Deutschland

A nationwide interdisciplinary intervention study in 106 German organic dairy farms was carried out in order to develop preventive animal health management strategies for mastitis and metabolic disorders and to implement and validate this concept. After an initial farm visit focusing on the health situation and the potential risk factors includ-ing housing, herd management, feeding and forage production, individual evidence-based advice was provided by the project team. Intervention measures to improve herd health were implemented and their effectiveness was monitored for two years. Udder health regarding milk somatic cell count and treatment incidence for mastitis improved significantly, whereas the percentage of dry-off-treatments with antibiotics and internal teat-sealers increased significantly. Considering indicators of metabolic health, there was an improvement in treatment incidence of milk fever and ketosis, but the percentage of cows with a fat-protein-ratio above 1.5 in the first 100 days in milk -as indication of subclinical ketosis- did not change

Stoffwechselbelastungen zu Laktationsbeginn und ihr Einfluss auf die Eutergesundheit in ökologisch wirtschaftenden Milchviehbetrieben

As a part of the study „Health and performance of dairy cows in organic farming from an interdisciplinary point of view – an (intervention-) study on metabolic disorders and mastitis with regard to forage production, feeding management and husbandry practices” different udder health and metabolic parameters were determined in 106 dairy farms in Germany between January 2008 and April 2010. The objective of this study was to evaluate and compare udder health and metabolic data in dry period and early lactation within the scope of a preliminary analysis. The analysis shows that relations exist between disturbances of the metabolism health and the udder health. Significant correlations between ketosis and hypocalcämia and udder health make clear that their control is vital for animal health management in organic dairy farms

Risiken und Chancen der Stoffwechsel- und Eutergesundheit im Zeitraum der Trockenperiode und der Frühlaktation in ökologisch wirtschaftenden Milchviehbetrieben

As a part of the study 'Health and performance of dairy cows in organic farming from an interdisciplinary point of view 13 an (intervention-) study on metabolic disorders and mastitis with regard to forage production, feeding management and husbandry practices' different udder health and metabolic variables were determined in 106 dairy farms in Germany between January 2008 and April 2010. The objective of this study was to evaluate udder health risks and metabolic risks in dry period and early lactation. Udder health and metabolic situation were similar to conventional dairy farms. Identified risks for metabolic health and udder health lay in the feeding area (homogenous feeding without a huge variation in body condition in lactation and dry period) and in the dry period therapy

Status quo der Tiergesundheitssituation in der ökologischen Milchviehhaltung in Deutschland - Ergebnisse einer repräsentativen bundesweiten Felderhebung

Die ökologische Tierhaltung hat das zentrale Anliegen, über vorbeugende Maßnahmen die Tiergesundheit zu erhalten und den Einsatz allopathischer Tierarzneimittel auf ein Mindestmaß zu reduzieren. Erkrankungskomplexe wie Eutergesundheits- und Stoffwechselstörungen sowie klinische Lahmheiten spielen jedoch auch in der ökologischen Milchviehhaltung eine große Rolle. Im Rahmen des Bundesprogramms Ökologischer Landbau wurde aus diesem Grund ein interdisziplinär angelegtes Projekt initiiert, das sich Fragen der Tiergesundheit in der ökologischen Milchviehhaltung widmet. Im Mittelpunkt dieser Interventionsstudie steht eine bundesweite Felderhebung mit insgesamt 106 ökologisch wirtschaftenden Milchviehbetrieben, die zum Ziel hat, anhand einer repräsentativen Praxiserhebung eine Datengrundlage für die Entwicklung einzelbetrieblicher Handlungsempfehlungen zu schaffen sowie deren Effektivität im Hinblick auf eine Verbesserung der Tiergesundheitssituation zu überprüfen. Hierfür fanden vier Betriebsbesuche in einer Praxisphase von zwei Jahren statt. Als Basis dienen ausgewählte Indikatoren der Euter- und Stoffwechselgesundheit sowie diesbezügliche Einflussfaktoren aus Haltungsumwelt, Herdenführung, Fütterung und Futterbau. Dieser Beitrag bietet einen Überblick über die Tiergesundheitssituation der Betriebe im Verlauf der 2-jährigen Praxisphase. Die vorliegenden Ergebnisse belegen erneut die Bedeutung von (Euter- und Stoffwechsel-) Gesundheitsstörungen in der Praxis der ökologischen Milchviehhaltung. Die Größenordnungen lagen im Bereich von Angaben für konventionelle Milchviehbetriebe. Es besteht in allen Bereichen Optimierungsbedarf; gleichzeitig zeigt die große Variabilität zwischen den einzelnen Betrieben die auch unter Praxisbedingungen des ökologischen Landbaus vorhandenen Ausgestaltungsspielräume auf. Erste Auswertungen ergaben eine weitgehende Umsetzung der betriebsindividuellen Handlungsempfehlungen. Ein Jahr nach der Implementierung konnte eine nominelle Verbesserung der Tiergesundheitsindikatoren festgestellt werden. Ob sich diese Entwicklung der Tiergesundheitssituation im Projektverlauf auch statistisch absichern lässt (z. B. nominaler Rückgang der mittleren Inzidenz von Mastitisbehandlungen), ist Gegenstand der abschließenden Effektivitätskontrolle. Diese wird auch berücksichtigen, inwiefern in den entsprechenden Herdengesundheitsbereichen Handlungsempfehlungen ausgesprochen wurden bzw. ob Veränderungen auf die Umsetzung der einzelbetrieblichen Handlungsempfehlungen oder aber auf andere Faktoren wie z.B. jahresbedingte Schwankungen zurückzuführen sind

Villages and Urbanization

In this article comments by politician Boris Johnson and economist Edward Glaeser exemplify narratives of global urbanization that portray rural villages as redundant and perpetuate outdated notions of urban–rural division. Simultaneously, traditional urban–rural dialectics are distorted by divisive new urban projects like gated communities styled as villages. This paper argues for development models that acknowledge the vital environmental and economic roles played by rural villages, and opposes artificially created “villages” in cities. In so doing, alternative readings of rurality and villages by Rem Koolhaas, Brazilian land reformers, Mahatma Gandhi, and critics of contemporary Indian literature and urbanism are considered

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Development of a primary care-based complex care management intervention for chronically ill patients at high risk for hospitalization: a study protocol

Background: Complex care management is seen as an approach to face the challenges of an ageing society with increasing numbers of patients with complex care needs. The Medical Research Council in the United Kingdom has proposed a framework for the development and evaluation of complex interventions that will be used to develop and evaluate a primary care-based complex care management program for chronically ill patients at high risk for future hospitalization in Germany. Methods and design: We present a multi-method procedure to develop a complex care management program to implement interventions aimed at reducing potentially avoidable hospitalizations for primary care patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, or chronic heart failure and a high likelihood of hospitalization. The procedure will start with reflection about underlying precipitating factors of hospitalizations and how they may be targeted by the planned intervention (pre-clinical phase). An intervention model will then be developed (phase I) based on theory, literature, and exploratory studies (phase II). Exploratory studies are planned that entail the recruitment of 200 patients from 10 general practices. Eligible patients will be identified using two ways of 'case finding': software based predictive modelling and physicians' proposal of patients based on clinical experience. The resulting subpopulations will be compared regarding healthcare utilization, care needs and resources using insurance claims data, a patient survey, and chart review. Qualitative studies with healthcare professionals and patients will be undertaken to identify potential barriers and enablers for optimal performance of the complex care management program. Discussion: This multi-method procedure will support the development of a primary care-based care management program enabling the implementation of interventions that will potentially reduce avoidable hospitalizations

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.