Antenatal atazanavir: a retrospective analysis of pregnancies exposed to atazanavir.

INTRODUCTION: There are few data regarding the tolerability, safety, or efficacy of antenatal atazanavir. We report our clinical experience of atazanavir use in pregnancy. METHODS: A retrospective medical records review of atazanavir-exposed pregnancies in 12 London centres between 2004 and 2010. RESULTS: There were 145 pregnancies in 135 women: 89 conceived whilst taking atazanavir-based combination antiretroviral therapy (cART), "preconception" atazanavir exposure; 27 started atazanavir-based cART as "first-line" during the pregnancy; and 29 "switched" to an atazanavir-based regimen from another cART regimen during pregnancy. Gastrointestinal intolerance requiring atazanavir cessation occurred in five pregnancies. Self-limiting, new-onset transaminitis was most common in first-line use, occurring in 11.0%. Atazanavir was commenced in five switch pregnancies in the presence of transaminitis, two of which discontinued atazanavir with persistent transaminitis. HIV-VL < 50 copies/mL was achieved in 89.3% preconception, 56.5% first-line, and 72.0% switch exposures. Singleton preterm delivery (<37 weeks) occurred in 11.7% preconception, 9.1% first-line, and 7.7% switch exposures. Four infants required phototherapy. There was one mother-to-child transmission in a poorly adherent woman. CONCLUSIONS: These data suggest that atazanavir is well tolerated and can be safely prescribed as a component of combination antiretroviral therapy in pregnancy

A CLIPS-based expert system for the evaluation and selection of robots

This paper describes the development of a prototype expert system for intelligent selection of robots for manufacturing operations. The paper first develops a comprehensive, three-stage process to model the robot selection problem. The decisions involved in this model easily lend themselves to an expert system application. A rule-based system, based on the selection model, is developed using the CLIPS expert system shell. Data about actual robots is used to test the performance of the prototype system. Further extensions to the rule-based system for data handling and interfacing capabilities are suggested

Cost-effectiveness of forced air warming during sedation in the cardiac catheterisation laboratory

Aim To determine the cost-effectiveness of forced air warming during sedation in a cardiac catheterisation laboratory. Background Forced air warming improves thermal comfort in comparison with standard care. It is not known whether the extra costs required for forced air warming are good value. Design Cost-effectiveness analysis alongside a randomised controlled trial conducted in 2016-2017. Methods A cost-effectiveness analysis was undertaken using Monte Carlo simulations from input distributions to estimate costs and effects associated with using forced air warming to reduce risk of thermal discomfort for patients receiving sedation in a cardiac catheterisation laboratory. A range of willingness to pay threshold values were tested with results plotted on a cost-effectiveness acceptability curve. Costs were calculated in Australian currency ($AUD). Results Estimated total costs were$5.21 (SD 3.26) higher per patient for forced air warming in comparison to standard care. Estimated probability of success (rating of thermal comfort) was 0.16 (0.06) higher for forced air warming. Forced air warming becomes more likely to result in a net benefit than standard care at a willingness to pay threshold of $34. Conclusion Forced air warming could be considered cost-effective for procedures performed with sedation in a cardiac catheterisation laboratory if the extra cost of an incremental gain in thermal comfort is less than the decision maker’s willingness to pay for it. Therefore, those responsible for decision-making regarding use of forced air warming in the cardiac catheterisation laboratory can use results of our model to decide if it represents good value for their organisation