Changes in mortality of people living with HIV in South Africa and their potential implications for life assurers

CITATION:Strydom, M. L., Corubolo, D. & Nel, C. 2016. Changes in mortality of people living with HIV in South Africa and their potential implications for life assurers. South African Actuarial Journal, 16:1-33. doi:10.4314/saaj.v16i1.1.The original publication is available at http://www.actuarialsociety.org.zaThis research investigates the impact of improved (and improving) mortality experience in South Africa as a result of the increased (and increasing) access to antiretroviral treatment on South African life assurers, the entry-level insurance market and the wider South African economy. The research focuses on various potential impacts on the entry-level insurance market, including new business profitability, product development and pricing, market penetration and the potential for increased savings. This research has been done with the assistance of four of the main South African life offices and also draws on the new THEMBISA AIDS model on which a working paper has been produced. The research is based on the THEMBISA model in order to investigate the potential impact of alternative mortality scenarios on typical entry-level products within the industry where the scenarios have been based on actual current and proposed antiretroviral roll-out strategies by the Department of Health. Potential improvements to profitability, premium reductions, benefit enhancements and cashback benefits are quantified using a profit test model for entry-level market products.http://www.actuarialsociety.org.za/Journal&Articles/changes-in-mortality-of-people-living-with-hiv-in-south-africa-and-their-potential-implications-for-life-assurers/Publisher's versio

Evaluation of remote monitoring of parturition in dairy cattle as a new tool for calving management.

Abstract Background Proper calving management of dairy herds is a crucial aspect of the bovine life cycle, as it has profound effects on calf viability and on the post-partum course of the dam. The objectives of this study were to monitor the calving process through the use of a remote alarm system and to determine the impact of prompt emergency obstetric procedures in case of dystocia for the prevention of stillbirths and post-partum reproductive pathologies, and for improving herd fertility. Six groups of experimental animals were studied: monitored heifers (n\u2009=\u200960) and multiparous cows (n\u2009=\u200960) were compared with non-observed animals (n\u2009=\u200960 heifers and n\u2009=\u200960 multiparous) giving birth during the same time period and housed in the calving barn, and with unmonitored animals placed in a dry zone (n\u2009=\u2009240 heifers and n\u2009=\u2009112 multiparous cows). Results The incidence of dystocia ranged from a minimum of 23.4% (monitored multiparous cows) to a maximum of 33.3% (monitored heifers), and there were no differences compared with control groups. However, the rate of stillbirth was higher in control groups than in the monitored groups (P\u2009<\u20090.01). Among both heifers and multiparous cows, the incidence of post-partum uterine infections was higher in the unmonitored animals both in the calving barn (P\u2009<\u20090.01) and in the dry zone (P\u2009<\u20090.05) compared with monitored animals. Among both heifers and multiparous cows, the control groups showed higher rates of foetal membrane retention than did the monitored groups (P\u2009<\u20090.001). The calving-to-conception interval was shorter; in particular, observed heifers showed a significant advantage of approximately 46 days compared with the unmonitored group (P\u2009<\u20090.001) and 32 days compared with the group in the calving barn (P\u2009<\u20090.05). Multiparous cows also had a reduction in the number of days open. Conclusions The remote alarm system used to monitor the calving process assured the prompt presence of personnel, improving both the cow\u2019s reproductive efficiency and neonatal viability. Keywords: Dairy cattle; Calving monitoring; Dystocia; Post-partum fertilit

Corneal toxicity of xylazine and clonidine, in combination with ketamine, in the rat.

PURPOSE: To compare the corneal toxicity of xylazine (XYL)/ketamine (KET) with that of clonidine (CLO)/KET in the rat, in the presence or not of the alpha(2)-adrenergic antagonist yohimbine (YOH). METHODS: XYL (10 mg/kg) and CLO (0.15 mg/kg) were administered subcutaneously in the rat in combination with KET (50 mg/kg), in the presence or not of YOH (2 mg/kg). RESULTS: The corneas immediately lost transparency and luster, but recovered within 120 min. By both light and electron microscopy, a marked stromal edema and alterations of all layers were observed. In addition, XYL/KET altered the permeability of the cornea as indicated by the augmented levels of (14)C-indomethacin, topically administered 30 min after the anesthetic combination. CONCLUSIONS: The mechanism of the corneal toxicity of XYL and CLO in the rat is unclear but we speculate that: (a) proptosis and inhibition of normal blinking did not play a major role because topical application of hyaluronic acid did not protect against it; corneal decompensation, edema and opacification could be due to (b) osmotic or (c) mechanical endothelial stress: the first resulting from the sudden increase of the glucose concentration in the aqueous humor due to the well-known inhibition of insulin release by alpha(2)-adrenergic agonists, and the second from the acute elevation of intraocular pressure caused by these alpha(2)-adrenergic mydriatics in the rat; (d) addition, XYL and CLO could act by directly interacting with local alpha(2)- or, possibly, alpha(1)-adrenergic receptors, whose function is still not clear but probably essential for corneal homeostasis

Corneal toxicity of xylazine and clonidine, in combination with ketamine, in the rat

PURPOSE: To compare the corneal toxicity of xylazine (XYL)/ketamine (KET) with that of clonidine (CLO)/KET in the rat, in the presence or not of the alpha(2)-adrenergic antagonist yohimbine (YOH). RESULTS: The corneas immediately lost transparency and luster, but recovered within 120 min. By both light and electron microscopy, a marked stromal edema and alterations of all layers were observed. In addition, XYL/KET altered the permeability of the cornea as indicated by the augmented levels of (14)C-indomethacin, topically administered 30 min after the anesthetic combination. CONCLUSIONS: The mechanism of the corneal toxicity of XYL and CLO in the rat is unclear but we speculate that: (a) proptosis and inhibition of normal blinking did not play a major role because topical application of hyaluronic acid did not protect against it; corneal decompensation, edema and opacification could be due to (b) osmotic or (c) mechanical endothelial stress: the first resulting from the sudden increase of the glucose concentration in the aqueous humor due to the well-known inhibition of insulin release by alpha(2)-adrenergic agonists, and the second from the acute elevation of intraocular pressure caused by these alpha(2)-adrenergic mydriatics in the rat; (d) addition, XYL and CLO could act by directly interacting with local alpha(2)- or, possibly, alpha(1)-adrenergic receptors, whose function is still not clear but probably essential for corneal homeostasis

Results of a walk‐above vertical seismic profiling survey acquired at the Thônex‐01 geothermal well (Switzerland) to delineate fractured carbonate formations for geothermal development

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