Human immunodeficiency virus (HIV) in Washington, D.C.: Prevalence of antiretroviral resistance in treatment naïve patients from 2007 to 2010

HIV treatment has been greatly impacted by transmitted resistance to antiretrovirals (ARV). Several studies have documented resistance in naïve individuals and estimates of transmitted drug resistance mutations range from \u3c5% to as high as 25%. Washington, D.C. has one of the highest human immunodeficiency virus (HIV) prevalence rates in the United States (3.2% in 2009), but local data regarding the frequency of major mutations and antiretroviral (ARV) resistance has been limited. Medical records of HIV positive, ARV-naïve adults at two facilities in Washington, D.C., The George Washington University Medical Center and the Veterans Affairs Medical Center, were retrospectively analyzed in subjects who had genotypic resistance testing from 2007 to 2010. Of 407 ARV-naïve patients, at least one transmitted drug resistance mutation was detected in 17% of our patients, with non-nucleoside reverse transcriptase (NNRTI) mutations observed in 15%. Among patients with at least one reverse transcriptase (RT) or major protease region (Pr) resistance mutation, 85% had resistance against a single ARV class. Dual and triple class resistance mutations were seen in 8 patients (2%) and 3 patients (0.7%), respectively. Most of the multiple class resistance was seen in 2010. A gradual increase in NNRTI resistance was noted during 2008 to 2010. Our prevalence of transmitted RT, major Pr mutations (17.4%) and ARV resistance (8.6%) were high but similar to rates reported by others within the United States. Given the high HIV prevalence in the District of Columbia, this has important implications for treatment of these ARV-naïve patients

Controlling Groundwater Exploitation Through Economic Instruments: Current Practices, Challenges and Innovative Approaches

Groundwater can be considered as a common-pool resource, is often overexploited and, as a result, there are growing management pressures. This chapter starts with a broad presentation of the range of economic instruments that can be used for groundwater management, considering current practices and innovative approaches inspired from the literature on Common Pool Resources management. It then goes on with a detailed presentation of groundwater allocation policies implemented in France, the High Plains aquifer in the USA, and Chile. The chapter concludes with a discussion of social and political difficulties associated with implementing economic instruments for groundwater management

Knowledge Protection in Firms:Theory and Evidence from HP Labs

We would like to thank Raluca Bunduchi, Wes Cohen, David Pym, seminar audiences at Duke University and Durham University, and especially Ashish Arora, for very helpful discussions and remarks. We are particularly grateful for the time and effort that many managers and researchers at HP Labs devoted to this research. The authors also gratefully acknowledge the support of the UK Technology Strategy Board grants "Cloud Stewardship Economics" (Swierzbinski, Patacconi, Williams) and "Trust Economics" (Williams) and the European Commission Seventh Framework Program for Research and Technological Development (FP7) project "SECONOMICS" (Williams) grant agreement 285223. All remaining errors are ours.Publisher PD

Characteristics and severity of disease among 100 cases of imported Malaria seen at a U.S. University Hospital, 2000–2017

Copyright © 2018 by The American Society of Tropical Medicine and Hygiene. Malaria acquired in endemic areas poses a substantial risk to travelers arriving in or returning to the United States. Timely diagnosis and recognition of severe illness are crucial; however, many U.S.-based clinicians lack familiarity with this disease. We conducted a retrospective review of 100 cases of malaria in adults seen at a single urban university hospital during 2000–2017. Descriptive and analytical statistics were calculated, including logistic regression modeling case severity. Most of the patients presented with Plasmodium falciparum (76%), most commonly after travel from sub-Saharan Africa (94%). Prior malaria experience was common (50%), but adherence to a prophylactic regimen was exceedingly rare (4%). Twenty-one patients had severe malaria, including 10 with cerebral malaria. Severity was predicted by high parasitemia, bandemia, hypoglycemia, and hypotension at the time of presentation. In 24 patients, the initial treatment regimen was changed, usually because of the appearance of clinical deterioration or drug toxicity. One patient required intravenous artesunate. All patients survived, although one suffered fetal loss. Among 30 patients initially evaluated at other institutions, 43% had been treated for an alternative diagnosis. The most common reasons for transfer of patients to our hospital were inadequate facilities and lack of expertise with malaria. There needs to be increased awareness among U.S.-based travelers and clinicians regarding malaria as a potentially lethal condition, emphasizing the use of appropriate prophylaxis. Our simple model of disease severity could serve frontline physicians when deciding which patients should be admitted to the intensive care unit or transferred for higher level care

Intertemporal self-selection with multiple buyers

We consider a monopolist selling durable goods to consumers with unit demands but different preferences for quality. The seller can offer items of different quality at the same time to induce buyers to self-select, as in Mussa-Rosen (1978), but is not artificially constrained to offer only one such menu. Instead the seller can offer without precommitment a sequence of menus over time. In the two-buyer case where the seller has complete information about each buyer's marginal valuation for quality, the seller's profits exceed what can be obtained from a single menu and sometimes approximate the profits of a perfectly discriminating monopolist. In companion papers (Bagnoli et al., 1990, 1992), we show that these conclusions continue to hold (1) in the infinite-horizon case with any finite number of buyers and (2) in two-period examples where the seller has incomplete information about buyer preferences.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46113/1/199_2005_Article_BF01212331.pd