Eflornithine is a cost-effective alternative to melarsoprol for the treatment of second-stage human West African trypanosomiasis in Caxito, Angola.

OBJECTIVE: To compare the cost-effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis. METHOD: We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost-effectiveness analysis, comparing the efficiency of an eflornithine-based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included. RESULTS: Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost-effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included. CONCLUSION: Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost-effective. Switching from melarsoprol to eflornithine can be considered as a cost-effective option according to the WHO choice criteria

The liminality of training spaces: Places of private/public transitions

This paper draws upon research, conducted for the London West Learning and Skills Council, on the training experiences of women with dependent children. One of the striking revelations of the research, we suggest, is the way in which training spaces are used and perceived by women, which are often at odds with government intentions. To help make sense of women’s use of and motivation for training we utilise the concept of ‘liminality’ and the private/public imbrication to explain the ways in which women use, or are discouraged from using, training spaces. Further, how the varied and multiple uses women in our research have put training to in their own lives has encouraged us to rethink the relationship between the private and the public more generally. In the light of this, we suggest that training and the places in which training take place, have been neglected processes and spaces within feminist geography and might usefully be explored further to add to an extensive literature on women’s caring and domestic roles and their role in the paid workplace

Frequency of HIV testing among gay and bisexual men in the UK: implications for HIV prevention

Objectives: The aim of the study was to explore HIV testing frequency among UK men who have sex with men (MSM) in order to direct intervention development. Methods: Cross-sectional surveys were completed by 2409 MSM in Edinburgh, Glasgow and London in 2011 and a Scotland-wide online survey was carried out in 2012/13. The frequency of HIV testing in the last 2 years was measured. Results: Overall, 21.2% of respondents reported at least four HIV tests and 33.7% reported two or three tests in the last 2 years, so we estimate that 54.9% test annually. Men reporting at least four HIV tests were younger and less likely to be surveyed in London. They were more likely to report higher numbers of sexual and anal intercourse partners, but not “higher risk” unprotected anal intercourse (UAI) with at least two partners, casual partners and/or unknown/discordant status partners in the previous 12 months. Only 26.7% (238 of 893) of men reporting higher risk UAI reported at least four tests. Among all testers (n = 2009), 56.7% tested as part of a regular sexual health check and 35.5% tested following a risk event. Differences were observed between surveys, and those testing in response to a risk event were more likely to report higher risk UAI. Conclusions: Guidelines recommend that all MSM test annually and those at “higher risk” test more frequently, but our findings suggest neither recommendation is being met. Additional efforts are required to increase testing frequency and harness the opportunities provided by biomedical HIV prevention. Regional, demographic and behavioural differences and variations in the risk profiles of testers suggest that it is unlikely that a “one size fits all” approach to increasing the frequency of testing will be successful

A level playing ‘field’? A Bourdieusian analysis of the career aspirations of further education students on sports courses

There is currently a distinct dearth of research into how sports students’ career aspirations are formed during their post-compulsory education. This article, based on an ethnographic study of sport students in tertiary education, draws on data collected from two first-year cohorts (n = 34) on two different courses at a further education college in England. The study draws on ethnographic observations, and semi-structured group interviews, to examine in-depth the contrasting occupational perspectives emergent within these two groups of mainly working-class students, and how specific cultural practices affect students’ career aspirations. Utilising a Bourdieusian framework, the paper analyses the internalised, often latent cultural practices that impact upon these students’ diverse career aspirations. The hitherto under-researched dimension of inter-habitus interaction and also the application of doxa are outlined. The article reveals how the two student cohorts are situated within a complex field of relations, where struggles for legitimisation, academic accomplishment and numerous forms of lucrative capital become habituated. The study offers salient Bourdieusian-inspired insights into the career aspirations of these predominantly working-class students and the ways in which certain educational practices contribute to the production and reproduction of class inequalities

Multi-System Collaboration: Supporting Individuals from Pre-employment Through Employment and Community Engagement Across the Life Course

In concert with the Institute for Community Inclusion (ICI) at the University of Massachusetts Boston, the National Association of State Directors of Developmental Disabilities Services (NASDDDS) identified potential topical areas for policy white papers that influence employment outcomes and services for individuals served by state intellectual/developmental disabilities (I/DD) agencies. This is the third white paper in a series of five

Estimating the overdispersion in COVID-19 transmission using outbreak sizes outside China.

Background: A novel coronavirus disease (COVID-19) outbreak has now spread to a number of countries worldwide. While sustained transmission chains of human-to-human transmission suggest high basic reproduction number R 0, variation in the number of secondary transmissions (often characterised by so-called superspreading events) may be large as some countries have observed fewer local transmissions than others. Methods: We quantified individual-level variation in COVID-19 transmission by applying a mathematical model to observed outbreak sizes in affected countries. We extracted the number of imported and local cases in the affected countries from the World Health Organization situation report and applied a branching process model where the number of secondary transmissions was assumed to follow a negative-binomial distribution. Results: Our model suggested a high degree of individual-level variation in the transmission of COVID-19. Within the current consensus range of R 0 (2-3), the overdispersion parameter k of a negative-binomial distribution was estimated to be around 0.1 (median estimate 0.1; 95% CrI: 0.05-0.2 for R0 = 2.5), suggesting that 80% of secondary transmissions may have been caused by a small fraction of infectious individuals (~10%). A joint estimation yielded likely ranges for R 0 and k (95% CrIs: R 0 1.4-12; k 0.04-0.2); however, the upper bound of R 0 was not well informed by the model and data, which did not notably differ from that of the prior distribution. Conclusions: Our finding of a highly-overdispersed offspring distribution highlights a potential benefit to focusing intervention efforts on superspreading. As most infected individuals do not contribute to the expansion of an epidemic, the effective reproduction number could be drastically reduced by preventing relatively rare superspreading events

Tools for Deconstructing Gauge Theories in AdS5

We employ analytical methods to study deconstruction of 5D gauge theories in the AdS5 background. We demonstrate that using the so-called q-Bessel functions allows a quantitative analysis of the deconstructed setup. Our study clarifies the relation of deconstruction with 5D warped theories.Comment: 30 pages; v2: several refinements, references adde

Renewable energy in remote communities

This article is the result of a competitively tendered University-funded project, this brings together two major Government Policy areas: sustainable communities and use of carbon fuels, and is aimed at influencing the policy debate on the difficulties of linking remote communities to renewable energy production because of poor distribution networks. Linkage with the Sustainable Communities agenda is an essential ingredient, as the proposal is that the renewable energy technologies will be installed and maintained by the communities themselves