Cost-effectiveness of point-of-care viral load monitoring of antiretroviral therapy in resource-limited settings: mathematical modelling study

BACKGROUND Monitoring of HIV viral load in patients on combination antiretroviral therapy (ART) is not generally available in resource-limited settings. We examined the cost-effectiveness of qualitative point-of-care viral load tests (POC-VL) in sub-Saharan Africa. DESIGN Mathematical model based on longitudinal data from the Gugulethu and Khayelitsha township ART programmes in Cape Town, South Africa. METHODS Cohorts of patients on ART monitored by POC-VL, CD4 cell count or clinically were simulated. Scenario A considered the more accurate detection of treatment failure with POC-VL only, and scenario B also considered the effect on HIV transmission. Scenario C further assumed that the risk of virologic failure is halved with POC-VL due to improved adherence. We estimated the change in costs per quality-adjusted life-year gained (incremental cost-effectiveness ratios, ICERs) of POC-VL compared with CD4 and clinical monitoring. RESULTS POC-VL tests with detection limits less than 1000 copies/ml increased costs due to unnecessary switches to second-line ART, without improving survival. Assuming POC-VL unit costs between US$5 and US$20 and detection limits between 1000 and 10,000 copies/ml, the ICER of POC-VL was US$4010-US$9230 compared with clinical and US$5960-US$25540 compared with CD4 cell count monitoring. In Scenario B, the corresponding ICERs were US$2450-US$5830 and US$2230-US$10380. In Scenario C, the ICER ranged between US$960 and US$2500 compared with clinical monitoring and between cost-saving and US$2460 compared with CD4 monitoring. CONCLUSION The cost-effectiveness of POC-VL for monitoring ART is improved by a higher detection limit, by taking the reduction in new HIV infections into account and assuming that failure of first-line ART is reduced due to targeted adherence counselling.

Reinfection by untreated partners of people treated for Chlamydia trachomatis and Neisseria gonorrhoeae: mathematical modelling study

OBJECTIVES Reinfection after treatment for Chlamydia trachomatis or Neisseria gonorrhoeae reduces the effect of control interventions. We explored the impact of delays in treatment of current partners on the expected probability of reinfection of index cases using a mathematical model. METHODS We used previously reported parameter distributions to calculate the probability that index cases would be reinfected by their untreated partners. We then assumed different delays between index case and partner treatment to calculate the probabilities of reinfection. RESULTS In the absence of partner treatment, the medians of the expected reinfection probabilities are 19.4% (IQR 9.2-31.6%) for C trachomatis and 12.5% (IQR 5.6-22.2%) for N gonorrhoeae. If all current partners receive treatment 3 days after the index case, the expected reinfection probabilities are 4.2% (IQR 2.1-6.9%) for C trachomatis and 5.5% (IQR 2.6-9.5%) for N gonorrhoeae. CONCLUSIONS Quicker partner referral and treatment can substantially reduce reinfection rates for C trachomatis and N gonorrhoeae by untreated partners. The formula we used to calculate reinfection rates can be used to inform the design of randomised controlled trials of novel partner notification technologies like accelerated partner therapy.

Inverse modelling of the 14C bomb pulse in stalagmites to constrain the dynamics of soil carbon cycling at selected European cave sites

The decomposition of soil organic matter (SOM) is temperature dependent, but its response to a future warmer climate remains equivocal. Enhanced rates of decomposition of SOM under increased global temperatures might cause higher CO2 emissions to the atmosphere, and could therefore constitute a strong positive feedback. The magnitude of this feedback however remains poorly understood, primarily because of the difficulty in quantifying the temperature sensitivity of stored, recalcitrant carbon that comprises the bulk (>90%) of SOM in most soils. In this study we investigated the effects of climatic conditions on soil carbon dynamics using the attenuation of the 14C ‘bomb’ pulse as recorded in selected modern European speleothems. These new data were combined with published results to further examine soil carbon dynamics, and to explore the sensitivity of labile and recalcitrant organic matter decomposition to different climatic conditions. Temporal changes in 14C activity inferred from each speleothem was modelled using a three pool soil carbon inverse model (applying a Monte Carlo method) to constrain soil carbon turnover rates at each site. Speleothems from sites that are characterised by semi-arid conditions, sparse vegetation, thin soil cover and high mean annual air temperatures (MAATs), exhibit weak attenuation of atmospheric 14C ‘bomb’ peak (a low damping effect, D in the range: 55–77%) and low modelled mean respired carbon ages (MRCA), indicating that decomposition is dominated by young, recently fixed soil carbon. By contrast, humid and high MAAT sites that are characterised by a thick soil cover and dense, well developed vegetation, display the highest damping effect (D = c. 90%), and the highest MRCA values (in the range from 350 ± 126 years to 571 ± 128 years). This suggests that carbon incorporated into these stalagmites originates predominantly from decomposition of old, recalcitrant organic matter. SOM turnover rates cannot be ascribed to a single climate variable, e.g. (MAAT) but instead reflect a complex interplay of climate (e.g. MAAT and moisture budget) and vegetation development.

Simplified modelling of bridge abutments-soil interaction under seismic effects

A simplified model is proposed to show the importance that the dynamic soil-abutment interaction can have in the global behavior of bridges submitted to seismic loading. The modification of natural frequency and damping properties is shown in graphic form for typical short span bridges of the integral deck-abutment type for longitudinal vibrations or general ones for transverse vibrations.

Effect of reservoir tillage on rainwater harvesting and soil erosion control under a developed rainfall simulator.

Soil erosion is a serious environmental threat in the Mediterranean region due to torrential rainfalls, and it contributes to the degradation of agricultural land. Techniques such as rainwater harvesting may improve soil water storage and increase agricultural productivity, which could result in more effective land usage. Reservoir tillage is an effective system of harvesting rainwater, but it has not been scientifically evaluated like other tillage systems. Its suitability for the conditions in Spain has not been determined. To investigate and quantify water storage from reservoir tillage and how it could be adapted to improve infiltration of harvested rainwater, a laboratory-scale rainfall simulator was developed. Rainfall characteristics, including rainfall intensity, spatial uniformity and raindrop size, confirm that natural rainfall conditions are simulated with sufficient accuracy. The simulator was auto-controlled by a solenoid valve and three pressure nozzles were used to spray water corresponding to five rainfall intensities ranging from 36 to 112 mm h-1 for 3 to 101-year return period with uniformity coefficients between 83 and 94%. In order to assess the reservoir tillage method under surface slopes of 0, 5, and 10%, three soil scooping devices with identical volume were used to make depressions in the following forms: a) truncated square pyramid, b) triangular prism, and c) truncated cone. These depressions were compared to a control soil surface with no depression. For the loam soil used in this study, results show that reservoir tillage was able to reduce soil erosion and surface runoff and significantly increase infiltration. There was significant difference between the depressions and the control. Compared to the control, depression (a) reduced surface runoff by about 61% and the sediment yield concentration by about 79%.

Modelling of landslides propagation with SPH : effects of rheology and pore water pressure

El estudio desarrollado en este trabajo de tesis se centra en la modelización numérica de la fase de propagación de los deslizamientos rápidos de ladera a través del método sin malla Smoothed Particle Hydrodynamics (SPH). Este método tiene la gran ventaja de permitir el análisis de problemas de grandes deformaciones evitando operaciones costosas de remallado como en el caso de métodos numéricos con mallas tal como el método de los Elementos Finitos. En esta tesis, particular atención viene dada al rol que la reología y la presión de poros desempeñan durante estos eventos. El modelo matemático utilizado se basa en la formulación de Biot-Zienkiewicz v - pw, que representa el comportamiento, expresado en términos de velocidad del esqueleto sólido y presiones de poros, de la mezcla de partículas sólidas en un medio saturado. Las ecuaciones que gobiernan el problema son: • la ecuación de balance de masa de la fase del fluido intersticial, • la ecuación de balance de momento de la fase del fluido intersticial y de la mezcla, • la ecuación constitutiva y • una ecuación cinemática. Debido a sus propiedades geométricas, los deslizamientos de ladera se caracterizan por tener una profundidad muy pequeña frente a su longitud y a su anchura, y, consecuentemente, el modelo matemático mencionado anteriormente se puede simplificar integrando en profundidad las ecuaciones, pasando de un modelo 3D a 2D, el cual presenta una combinación excelente de precisión, sencillez y costes computacionales. El modelo propuesto en este trabajo se diferencia de los modelos integrados en profundidad existentes por incorporar un ulterior modelo capaz de proveer información sobre la presión del fluido intersticial a cada paso computacional de la propagación del deslizamiento. En una manera muy eficaz, la evolución de los perfiles de la presión de poros está numéricamente resuelta a través de un esquema explicito de Diferencias Finitas a cada nodo SPH. Este nuevo enfoque es capaz de tener en cuenta la variación de presión de poros debida a cambios de altura, de consolidación vertical o de cambios en las tensiones totales. Con respecto al comportamiento constitutivo, uno de los problemas principales al modelizar numéricamente deslizamientos rápidos de ladera está en la dificultad de simular con la misma ley constitutiva o reológica la transición de la fase de iniciación, donde el material se comporta como un sólido, a la fase de propagación donde el material se comporta como un fluido. En este trabajo de tesis, se propone un nuevo modelo reológico basado en el modelo viscoplástico de Perzyna, pensando a la viscoplasticidad como a la llave para poder simular tanto la fase de iniciación como la de propagación con el mismo modelo constitutivo. Con el fin de validar el modelo matemático y numérico se reproducen tanto ejemplos de referencia con solución analítica como experimentos de laboratorio. Finalmente, el modelo se aplica a casos reales, con especial atención al caso del deslizamiento de 1966 en Aberfan, mostrando como los resultados obtenidos simulan con éxito estos tipos de riesgos naturales. The study developed in this thesis focuses on the modelling of landslides propagation with the Smoothed Particle Hydrodynamics (SPH) meshless method which has the great advantage of allowing to deal with large deformation problems by avoiding expensive remeshing operations as happens for mesh methods such as, for example, the Finite Element Method. In this thesis, special attention is given to the role played by rheology and pore water pressure during these natural hazards. The mathematical framework used is based on the v - pw Biot-Zienkiewicz formulation, which represents the behaviour, formulated in terms of soil skeleton velocity and pore water pressure, of the mixture of solid particles and pore water in a saturated media. The governing equations are: • the mass balance equation for the pore water phase, • the momentum balance equation for the pore water phase and the mixture, • the constitutive equation and • a kinematic equation. Landslides, due to their shape and geometrical properties, have small depths in comparison with their length or width, therefore, the mathematical model aforementioned can then be simplified by depth integrating the equations, switching from a 3D to a 2D model, which presents an excellent combination of accuracy, computational costs and simplicity. The proposed model differs from previous depth integrated models by including a sub-model able to provide information on pore water pressure profiles at each computational step of the landslide's propagation. In an effective way, the evolution of the pore water pressure profiles is numerically solved through a set of 1D Finite Differences explicit scheme at each SPH node. This new approach is able to take into account the variation of the pore water pressure due to changes of height, vertical consolidation or changes of total stress. Concerning the constitutive behaviour, one of the main issues when modelling fast landslides is the difficulty to simulate with the same constitutive or rheological model the transition from the triggering phase, where the landslide behaves like a solid, to the propagation phase, where the landslide behaves in a fluid-like manner. In this work thesis, a new rheological model is proposed, based on the Perzyna viscoplastic model, thinking of viscoplasticity as the key to close the gap between the triggering and the propagation phase. In order to validate the mathematical model and the numerical approach, benchmarks and laboratory experiments are reproduced and compared to analytical solutions when possible. Finally, applications to real cases are studied, with particular attention paid to the Aberfan flowslide of 1966, showing how the mathematical model accurately and successfully simulate these kind of natural hazards.

Modelling of short runout propagation landslides and debris flows

This paper proposes an extension of methods used to predict the propagation of landslides having a long runout to smaller landslides with much shorter propagation distances. The method is based on: (1) a depth-integrated mathematical model including the coupling between the soil skeleton and the pore fluids, (2) suitable rheological models describing the relation between the stress and the rate of deformation tensors for fluidised soils and (3) a meshless numerical method, Smooth Particle Hydrodynamics, which separates the computational mesh (or set of computational nodes) from the mesh describing the terrain topography, which is of structured type – thus accelerating search operations. The proposed model is validated using two examples for which there are analytical solutions, and then it is applied to two short runout landslides which happened in Hong Kong in 1995, for which there is available information.

Effect of reservoir tillage on rainwater havesting and soil erosion control under a developed rainfall simulator

Soil erosion is a serious environmental threat in the Mediterranean region due to torrential rainfalls, and it contributes to the degradation of agricultural land. Techniques such as rainwater harvesting may improve soil water storage and increase agricultural productivity, which could result in more effective land usage. Reservoir tillage is an effective system of harvesting rainwater, but it has not been scientifically evaluated like other tillage systems. Its suitability for the conditions in Spain has not been determined. To investigate and quantify water storage from reservoir tillage and how it could be adapted to improve infiltration of harvested rainwater, a laboratory-scale rainfall simulator was developed. Rainfall characteristics, including rainfall intensity, spatial uniformity and raindrop size, confirm that natural rainfall conditions are simulated with sufficient accuracy. The simulator was auto-controlled by a solenoid valve and three pressure nozzles were used to spray water corresponding to five rainfall intensities ranging from 36 to 112 mm h− 1 for 3 to 101-year return period with uniformity coefficients between 83 and 94%. In order to assess the reservoir tillage method under surface slopes of 0, 5, and 10%, three soil scooping devices with identical volume were used to make depressions in the following forms: a) truncated square pyramid, b) triangular prism, and c) truncated cone. These depressions were compared to a control soil surface with no depression. For the loam soil used in this study, results show that reservoir tillage was able to reduce soil erosion and surface runoff and significantly increase infiltration. There was significant difference between the depressions and the control. Compared to the control, depression (a) reduced surface runoff by about 61% and the sediment yield concentration by about 79%.

USLE and WEPP Soil Erosion Models: Their Applicability and Use in Generating Cover Values to Stabilize Soil in the Los Alamos, New Mexico Area

Soil erosion is a naturally occurring process that involves the detachment, transport, and deposition of soil particles. Disturbances such as thinning and wildfire can reduce cover greatly and increase erosion rates. Forest managers may use erosion prediction tools, such as the Universal Soil Loss Equation (USLE) and Water Erosion Prediction Project (WEPP) to estimate erosion rates and develop techniques to manage erosion. However, it is important to understand the differences and the applications of each model. Erosion rates were generated by each model and the model most applicable to the study site, Los Alamos, New Mexico was determined. It was also used to find the amount of cover needed to stabilize soil. The USLE is a simpler model and less complicated than a computer model like WEPP, and thus easier to manipulate to estimate cover values. Predicted cover values were compared to field cover values. Cover is necessary to establish effective erosion control guidelines.

Your land : a handbook of practical methods for preventing and curing soil erosion.

"A compilation of practical tried-and-proved methods which have been developed by state agricultural colleges and extension workers, U.S. soil conservation experts, and county agricultural agents."--p. [2] of cover.

A mathematical modelling technique for the analysis of the dynamics of a simple continuous EDA

This paper presents some initial attempts to mathematically model the dynamics of a continuous estimation of distribution algorithm (EDA) based on a Gaussian distribution and truncation selection. Case studies are conducted on both unimodal and multimodal problems to highlight the effectiveness of the proposed technique and explore some important properties of the EDA. With some general assumptions, we show that, for ID unimodal problems and with the (mu, lambda) scheme: (1). The behaviour of the EDA is dependent only on the general shape of the test function, rather than its specific form; (2). When initialized far from the global optimum, the EDA has a tendency to converge prematurely; (3). Given a certain selection pressure, there is a unique value for the proposed amplification parameter that could help the EDA achieve desirable performance; for ID multimodal problems: (1). The EDA could get stuck with the (mu, lambda) scheme; (2). The EDA will never get stuck with the (mu, lambda) scheme.