How to Estimate the Cost of Point-of-Care CD4 Testing in Program Settings: An Example Using the Alere Pima™ Analyzer in South Africa

Integrating POC CD4 testing technologies into HIV counseling and testing (HCT) programs may improve post-HIV testing linkage to care and treatment. As evaluations of these technologies in program settings continue, estimates of the costs of POC CD4 tests to the service provider will be needed and estimates have begun to be reported. Without a consistent and transparent methodology, estimates of the cost per CD4 test using POC technologies are likely to be difficult to compare and may lead to erroneous conclusions about costs and cost-effectiveness. This paper provides a step-by-step approach for estimating the cost per CD4 test from a provider's perspective. As an example, the approach is applied to one specific POC technology, the Pima™ Analyzer. The costing approach is illustrated with data from a mobile HCT program in Gauteng Province of South Africa. For this program, the cost per test in 2010 was estimated at $23.76 (material costs =$8.70; labor cost per test = $7.33; and equipment, insurance, and daily quality control =$7.72). Labor and equipment costs can vary widely depending on how the program operates and the number of CD4 tests completed over time. Additional costs not included in the above analysis, for on-going training, supervision, and quality control, are likely to increase further the cost per test. The main contribution of this paper is to outline a methodology for estimating the costs of incorporating POC CD4 testing technologies into an HCT program. The details of the program setting matter significantly for the cost estimate, so that such details should be clearly documented to improve the consistency, transparency, and comparability of cost estimates

Creating an appropriate tenure foundation for REDD+: The record to date and prospects for the future

Attention to tenure is a fundamental step in preparation for REDD+ implementation. Unclear and conflicting tenure has been the main challenge faced by the proponents of subnational REDD+ initiatives, and accordingly, they have expended much effort to remedy the problem. This article assesses how well REDD+ has performed in laying an appropriate tenure foundation. Field research was carried out in two phases (2010-2012 and 2013-2014) in five countries (Brazil, Peru, Cameroon, Tanzania, Indonesia) at 21 subnational initiatives, 141 villages (half targeted for REDD+ interventions), and 3,754 households. Three questions are posed: 1) What was the effect of REDD+ on perceived tenure insecurity of village residents?; 2) What are the main reasons for change in the level of tenure insecurity and security from Phase 1 to Phase 2 perceived by village residents in control and intervention villages?; and 3) How do intervention village residents evaluate the impact of tenure-related interventions on community well-being? Among the notable findings are that: 1) tenure insecurity decreases slightly across the whole sample of villages, but we only find that REDD+ significantly reduces tenure insecurity in Cameroon, while actually increasing insecurity of smallholder agricultural land tenure in Brazil at the household level; 2) among the main reported reasons for increasing tenure insecurity (where it occurs) are problems with outside companies, lack of title, and competition from neighboring villagers; and 3) views on the effect of REDD+ tenure-related interventions on community well-being lean towards the positive, including for interventions that restrain access to forest. Thus, while there is little evidence that REDD+ interventions have worsened smallholder tenure insecurity (as feared by critics), there is also little evidence that the proponents' efforts to address tenure insecurity have produced results. Work on tenure remains an urgent priority for safeguarding local livelihoods as well as for reducing deforestation. This will require increased attention to participatory engagement, improved reward systems, tenure policy reform, integration of national and local efforts, and "business-as-usual" interestsThis research is part of CIFOR’s Global Comparative Study on REDD+ (www.cifor.org/gcs). The funding partners that have supported this research include the Norwegian Agency for Development Cooperation (Norad) [grant numbers QZA-10/0468, QZA-12/0882, QZA-16/0110], the Australian Department of Foreign Affairs and Trade (DFAT) [grant numbers 46167, 63560], the European Commission (EC) [grant number DCI-ENV/2011/269-520], the International Climate Initiative (IKI) of the German Federal Ministry for the Environment, Nature Conservation, Building and Nuclear Safety (BMUB) [grant number KI II 7 - 42206-6/75], the United Kingdom Department for International Development (UKAID) [grant number TF069018], and the CGIAR Research Program on Forests, Trees and Agroforestry (CRP-FTA) [grant number TF No. 069018], with financial support from the donors contributing to the CGIAR Fund. David Solis provided a valuable service in reviewing our methods for taking into account attrition of households over time

Genetic variation in the HLA region is associated with susceptibility to herpes zoster.

Herpes zoster, commonly referred to as shingles, is caused by the varicella zoster virus (VZV). VZV initially manifests as chicken pox, most commonly in childhood, can remain asymptomatically latent in nerve tissues for many years and often re-emerges as shingles. Although reactivation may be related to immune suppression, aging and female sex, most inter-individual variability in re-emergence risk has not been explained to date. We performed a genome-wide association analyses in 22,981 participants (2280 shingles cases) from the electronic Medical Records and Genomics Network. Using Cox survival and logistic regression, we identified a genomic region in the combined and European ancestry groups that has an age of onset effect reaching genome-wide significance (P>1.0 × 10(-8)). This region tags the non-coding gene HCP5 (HLA Complex P5) in the major histocompatibility complex. This gene is an endogenous retrovirus and likely influences viral activity through regulatory functions. Variants in this genetic region are known to be associated with delay in development of AIDS in people infected by HIV. Our study provides further suggestion that this region may have a critical role in viral suppression and could potentially harbor a clinically actionable variant for the shingles vaccine

Gamma Lines without a Continuum: Thermal Models for the Fermi-LAT 130 GeV Gamma Line

Recent claims of a line in the Fermi-LAT photon spectrum at 130 GeV are suggestive of dark matter annihilation in the galactic center and other dark matter-dominated regions. If the Fermi feature is indeed due to dark matter annihilation, the best-fit line cross-section, together with the lack of any corresponding excess in continuum photons, poses an interesting puzzle for models of thermal dark matter: the line cross-section is too large to be generated radiatively from open Standard Model annihilation modes, and too small to provide efficient dark matter annihilation in the early universe. We discuss two mechanisms to solve this puzzle and illustrate each with a simple reference model in which the dominant dark matter annihilation channel is photonic final states. The first mechanism we employ is resonant annihilation, which enhances the annihilation cross-section during freezeout and allows for a sufficiently large present-day annihilation cross section. Second, we consider cascade annihilation, with a hierarchy between p-wave and s-wave processes. Both mechanisms require mass near-degeneracies and predict states with masses closely related to the dark matter mass; resonant freezeout in addition requires new charged particles at the TeV scale.Comment: 17 pages, 8 figure

The ethics of uncertainty for data subjects

Modern health data practices come with many practical uncertainties. In this paper, I argue that data subjects’ trust in the institutions and organizations that control their data, and their ability to know their own moral obligations in relation to their data, are undermined by significant uncertainties regarding the what, how, and who of mass data collection and analysis. I conclude by considering how proposals for managing situations of high uncertainty might be applied to this problem. These emphasize increasing organizational flexibility, knowledge, and capacity, and reducing hazard

Comparing angular and curved shapes in terms of implicit associations and approach/avoidance responses.

Most people prefer smoothly curved shapes over more angular shapes. We investigated the origin of this effect using abstract shapes and implicit measures of semantic association and preference. In Experiment 1 we used a multidimensional Implicit Association Test (IAT) to verify the strength of the association of curved and angular polygons with danger (safe vs. danger words), valence (positive vs. negative words) and gender (female vs. male names). Results showed that curved polygons were associated with safe and positive concepts and with female names, whereas angular polygons were associated with danger and negative concepts and with male names. Experiment 2 used a different implicit measure, which avoided any need to categorise the stimuli. Using a revised version of the Stimulus Response Compatibility (SRC) task we tested with a stick figure (i.e., the manikin) approach and avoidance reactions to curved and angular polygons. We found that RTs for approaching vs. avoiding angular polygons did not differ, even in the condition where the angles were more pronounced. By contrast participants were faster and more accurate when moving the manikin towards curved shapes. Experiment 2 suggests that preference for curvature cannot derive entirely from an association of angles with threat. We conclude that smoothly curved contours make these abstract shapes more pleasant. Further studies are needed to clarify the nature of such a preference

Dissolution dominating calcification process in polar pteropods close to the point of aragonite undersaturation

Thecosome pteropods are abundant upper-ocean zooplankton that build aragonite shells. Ocean acidification results in the lowering of aragonite saturation levels in the surface layers, and several incubation studies have shown that rates of calcification in these organisms decrease as a result. This study provides a weight-specific net calcification rate function for thecosome pteropods that includes both rates of dissolution and calcification over a range of plausible future aragonite saturation states (Omega_Ar). We measured gross dissolution in the pteropod Limacina helicina antarctica in the Scotia Sea (Southern Ocean) by incubating living specimens across a range of aragonite saturation states for a maximum of 14 days. Specimens started dissolving almost immediately upon exposure to undersaturated conditions (Omega_Ar,0.8), losing 1.4% of shell mass per day. The observed rate of gross dissolution was different from that predicted by rate law kinetics of aragonite dissolution, in being higher at Var levels slightly above 1 and lower at Omega_Ar levels of between 1 and 0.8. This indicates that shell mass is affected by even transitional levels of saturation, but there is, nevertheless, some partial means of protection for shells when in undersaturated conditions. A function for gross dissolution against Var derived from the present observations was compared to a function for gross calcification derived by a different study, and showed that dissolution became the dominating process even at Omega_Ar levels close to 1, with net shell growth ceasing at an Omega_Ar of 1.03. Gross dissolution increasingly dominated net change in shell mass as saturation levels decreased below 1. As well as influencing their viability, such dissolution of pteropod shells in the surface layers will result in slower sinking velocities and decreased carbon and carbonate fluxes to the deep ocean