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.

The effect of projections on dimension in the Heisenberg group

We prove analogs of classical almost sure dimension theorems for Euclidean projection mappings in the first Heisenberg group, equipped with a sub-Riemannian metric.

Horbat Kur — 2011 Preliminary Report

Published in English and Hebrew

Clinical primary flexor tendon repair and rehabilitation: The Bern Experience

In this chapter we present our experience with treatment of zone 2 flexor tendon repair using a six-strand repair technique combined with postoperative place-and-hold exercise. The six-strand Lim/Tsai repair technique combined with place-and-hold exercises demonstrated better digital function compared to a two-strand repair without place-and-hold exercises. Range of motion in the Lim/Tsai repair group appeared to be increased without a higher rate of ruptures but with a shorter rehabilitation period. The fact that the two groups differed in both suture techniques and rehabilitation programs made it impossible to know whether the better results in the group of Lim/Tsai were due to the six-strand repair or the place-and-hold exercises or both. Despite the obvious benefit of early active mobilization, an active motion protocol may not always be possible to apply in a substantial number of patients due to concomitant injuries, the quality of the surgical repair or patient factors (swelling, pain, limited compliance). Since August 2006 a staged rehabilitation program (“stop and go”) was introduced within our unit using early active controlled flexion (green), place-and-hold (yellow), or passive flexion exercises (red) introduced by Kleinert-Duran. Our experience using the six-strand suture repair technique and “stop and go” is outlined.

Sēder harê ʿôlām : bšraibung fun ali di in dr welṭ brihmṭi berig und di ṭugend woś ein jedr berg an zich hoṭ ...

Digitalisat der Ausg. Frankfurṭ an der Oder, [1791/92]

Región de Mendoza : Nordeste: Lavalle, Santa Rosa y La Paz

Regiones y Departamentos. Relatos de nuestra identidad es una serie que aborda las características turísticas, culturales e históricas de la provincia de Mendoza. En los 14 programas se han destacado y revalorizado las particularidades de cada uno de los departamentos de esta provincia argentina que se dividen en distintas regiones: Valle de Uco, Gran Mendoza, Zona Sur, Zona Este y Zona Nordeste NORDESTE, es un documental que resalta las particularidades de los departamentos de Santa Rosa, Lavalle y La Paz. En el bloque 1 conoceremos la historia del Nordeste comenzando por Lavalle, lugar que habitaron los Huarpes desde 1300 en adelante hasta la llegada de los españoles. A pesar de ésto, Lavalle es uno de los lugares que más tradición indígena ha mantenido. La Paz fue en sus comienzos una zona muy poco habitada realidad que cambió con la llegada del ferrocarril, para concluir con Santa Rosa, zona que alberga la mítica historia de Santos Guayana. En el bloque 2, repasaremos las características societales y culturales del Nordeste para finalizar en el bloque 3 detallando la oferta turística que ésta zona propone.