Modelling cost-effectiveness of syphilis detection strategies in prisoners: exploratory exercise in a Chilean male prison.

BACKGROUND: Syphilis, together with other sexually transmitted infections, remains a global public health problem that is far from controlled. People deprived of liberty are a vulnerable population. Control activities in prisons rely mostly on passive case detection, despite the existence of affordable alternatives that would allow switching to active case-finding strategies. Our objective was to develop a mathematical modelling framework for cost-effectiveness evaluation, from a health system perspective, of different approaches using rapid tests for the detection of syphilis in inmates' populations and to explore the results based on a Chilean male prison population. METHODS: A compartmental model was developed to characterize the transmission dynamics of syphilis inside a prison with the ongoing strategy (passive case detection, with VRDL + FTA-ABS), considering the entrance and exit of inmates over a 40 year period. The model allows simulation of the implementation of a reverse algorithm for the current situation (rapid test + VDRL), different screening strategies (entry point, massive periodically; both with rapid test + VDRL) and treatment of detected cases. The parameters for the exploratory exercise were obtained from systematic searches of indexed and grey literature and field work (EQ-5D questionnaire application and key actors interviews). Probabilistic sensitivity analysis was conducted to account for uncertainty in relevant parameters. RESULTS: The proposed framework allows the evaluation of different detection strategies. In this study, all the strategies were cost-effective in the baseline scenario when considering an ICER threshold of 1 Chilean GDP per capita (US$15,000). The strategies most likely to be cost-effective (over 80% probability) were: current situation with reverse algorithm, entry point screening and mass screening every two years; the latter was the most effective, achieving the lowest prevalence (0.7% and 1.7% over the period versus the 3% prevalence in the current situation). CONCLUSIONS: Mathematical modelling that considers the performance of different tests and detection strategies could be a useful tool for decision making. The exploratory results show the efficiency of adopting both the use of the rapid tests and performing active case detection to significantly reduce the burden of syphilis in Chilean prisons in the near future.

Effects of Seed-Applied Biofertilizers on Rhizosphere Biodiversity and Growth of Common Wheat (Triticum aestivum L.) in the Field.

In order to reduce chemical fertilization and improve the sustainability of common wheat (Triticum aestivum L.) cultivation, maintaining at the same time high production and quality standards, this study investigated the effects of three commercial biofertilizers on rhizosphere bacterial biomass, biodiversity and enzymatic activity, and on plant growth and grain yield in a field trial. The wheat seeds were inoculated with the following aiding microrganisms: (i) a bacterial consortium (Azospirillum spp. + Azoarcus spp. + Azorhizobium spp.); and two mycorrhizal fungal-bacterial consortia, viz. (ii) Rhizophagus irregularis + Azotobacter vinelandii, and (iii) R. irregularis + Bacillus megaterium + Frateuria aurantia, and comparisons were made with noninoculated controls. We demonstrate that all the biofertilizers significantly enhanced plant growth and nitrogen accumulation during stem elongation and heading, but this was translated into only small grain yield gains (+1%-4% vs controls). The total gluten content of the flour was not affected, but in general biofertilization significantly upregulated two high-quality protein subunits, i.e., the 81 kDa high-molecular-weight glutenin subunit and the 43.6 kDa low-molecular-weight glutenin subunit. These effects were associated with increases in the rhizosphere microbial biomass and the activity of enzymes such as ß-glucosidase, α-mannosidase, ß-mannosidase, and xylosidase, which are involved in organic matter decomposition, particularly when Rhizophagus irregularis was included as inoculant. No changes in microbial biodiversity were observed. Our results suggest that seed-applied biofertilizers may be effectively exploited in sustainable wheat cultivation without altering the biodiversity of the resident microbiome, but attention should be paid to the composition of the microbial consortia in order to maximize their benefits in crop cultivation.

Morphological Changes and Expressions of AOX1A, CYP81D8, and Putative PFP Genes in a Large Set of Commercial Maize Hybrids Under Extreme Waterlogging.

Waterlogging is a severe abiotic stressor causing significant growth impairment and yield losses in many crops. Maize is highly sensitive to the excess of water, and against the background of climate change there is an urgent need for deeper insights into the mechanisms of crop adaptation to waterlogging. In the present study, changes in maize morphology at the 4-5 leaf stage and the expression of three candidate genes for flooding tolerance in plants subjected to six continuous days of waterlogging were recorded in 19 commercial hybrids and in the inbred line B73, with the aim of investigating the current variability in cultivated hybrids and identifying useful morphological and molecular markers for screening tolerant genotypes. Here it was demonstrated that root parameters (length, area, biomass) were more impaired by waterlogging than shoot parameters (shoot height and biomass). Culm height generally increased in stressed plants (by up to +24% vs. controls), while shoot biomass was significantly reduced in only two hybrids. Root biomass was reduced in all the hybrids, by an average of 30%, and significantly in 7 hybrids, while root length and area were even more severely reduced, by 30-55% vs. controls, depending on the hybrid. The earlier appearance of aerial roots seemed to be associated with greater root injuries. In leaves, the transcript of the PFP enzyme (phosphofructokinase), which is involved in glycolytic reactions, was markedly up-regulated (up to double the values) in half the waterlogged hybrids, but down-regulated in the others. The transcript of CYP81D8 (ROS-related proteins) in waterlogged plants exhibited relevant increases or strong decreases in level, depending on the hybrid. The transcript of the AOX1A gene, coding for a mitochondrial respiratory electron transport chain-related protein, was markedly down-regulated in all the treated hybrids. Expression analysis of these genes under extreme waterlogging only partially correlate with the shoot and root growth impairments observed, and AOX1A seems to be the most informative of them.

Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa.

UNLABELLED: INTRODUCTION AND SETTING: Our analysis compares the most comprehensive epidemiologic and virologic surveillance data compiled to date for laboratory-confirmed H1N1pdm patients between 1 April 2009 - 31 January 2010 from five temperate countries in the Southern Hemisphere-Argentina, Australia, Chile, New Zealand, and South Africa. OBJECTIVE: We evaluate transmission dynamics, indicators of severity, and describe the co-circulation of H1N1pdm with seasonal influenza viruses. RESULTS: In the five countries, H1N1pdm became the predominant influenza strain within weeks of initial detection. South Africa was unique, first experiencing a seasonal H3N2 wave, followed by a distinct H1N1pdm wave. Compared with the 2007 and 2008 influenza seasons, the peak of influenza-like illness (ILI) activity in four of the five countries was 3-6 times higher with peak ILI consultation rates ranging from 35/1,000 consultations/week in Australia to 275/100,000 population/week in New Zealand. Transmission was similar in all countries with the reproductive rate ranging from 1.2-1.6. The median age of patients in all countries increased with increasing severity of disease, 4-14% of all hospitalized cases required critical care, and 26-68% of fatal patients were reported to have ≥1 chronic medical condition. Compared with seasonal influenza, there was a notable downward shift in age among severe cases with the highest population-based hospitalization rates among children <5 years old. National population-based mortality rates ranged from 0.8-1.5/100,000. CONCLUSIONS: The difficulty experienced in tracking the progress of the pandemic globally, estimating its severity early on, and comparing information across countries argues for improved routine surveillance and standardization of investigative approaches and data reporting methods.