Cost-effectiveness of voluntary HIV-1 counseling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania.

Background Access to HIV-1 voluntary counseling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings.\ud Methods\ud The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10 000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters.\ud Findings\ud HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year. The cost per HIV-1 infection averted was US$249 and$346, respectively, and the cost per DALY saved was $12·77 and$17·78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5·16-27·36 in Kenya, and$6·58-45·03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10·71 in Kenya and$13·39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8·36 in Kenya and$11·74 in Tanzania.\ud Interpretation\ud HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly

Evaluation of Stature Development During Childhood and Adolescence in Individuals with Familial Hypophosphatemic Rickets

This review was conducted to study the diagnosis, treatment, and growth progression in infants and adolescents with familial hypophosphatemic rickets. The bibliographic search was carried out utilizing the electronic databases MEDLINE, OVID, and LILACS and by direct research within the last 15 years using the keywords rickets, familial hypophosphatemia, vitamin D deficiency, stature growth, childhood, and adolescence. Article selection was done by comparing the evaluation of the growth in patients with familial hypophosphatemic rickets, including the variables that might affect them, for possible future therapeutic proposals. It is concluded that the most significant fact in the treatment of familial hypophosphatemic rickets in infancy was the magnitude of the final stature. The use of growth hormone can be helpful in these patients. However, research reporting treatments with the use of the growth hormone for rickets are controversial. The majority of the authors agree that treatment using vitamin D and phosphate enables some statural growth in cases of early diagnosis, reflecting a better prognosis

On the Crepant Resolution Conjecture in the Local Case

In this paper we analyze four examples of birational transformations between local Calabi-Yau 3-folds: two crepant resolutions, a crepant partial resolution, and a flop. We study the effect of these transformations on genus-zero Gromov-Witten invariants, proving the Coates-Corti-Iritani-Tseng/Ruan form of the Crepant Resolution Conjecture in each case. Our results suggest that this form of the Crepant Resolution Conjecture may also hold for more general crepant birational transformations. They also suggest that Ruan's original Crepant Resolution Conjecture should be modified, by including appropriate "quantum corrections", and that there is no straightforward generalization of either Ruan's original Conjecture or the Cohomological Crepant Resolution Conjecture to the case of crepant partial resolutions. Our methods are based on mirror symmetry for toric orbifolds.Comment: 27 pages. This is a substantially revised and shortened version of my preprint "Wall-Crossings in Toric Gromov-Witten Theory II: Local Examples"; all results contained here are also proved there. To appear in Communications in Mathematical Physic

Agent-based modeling and simulation to assess flood preparedness and recovery of manufacturing small and medium-sized enterprises

Severe flooding has caused major damage and disruption to households, communities, businesses, and organizations in many parts of the world. In the United Kingdom (UK), flooding has been responsible for significant losses to the economy due to its impact on businesses, 99.9% of which are Small and Medium-sized Enterprises (SMEs). This paper reports on how agent-based modeling and simulation has been developed and used to assess the effectiveness of a range of physical/structural and social preparedness adaptation measures that can be implemented by manufacturing SMEs to reduce the impact of and expedite recovery from a major flood event. Results indicate the effectiveness of combinations of these adaptation measures in relation to a one in 1000 year flood event that has been modeled and simulated in a key industrial area of the UK which, in addition to having experienced severe flooding, has a high concentration of SMEs

Navigating uncertainty and complexity: Higher education and the dilemma of employability

This paper reinforces growing social and economic demands for graduates who can navigate the uncertainty and complexity of rapidly transforming employment contexts. This aim is first addressed with an overview of the research on employability and the changing nature of work and employment. This is followed with a discussion of employability and career development within higher education. The article concludes by considering the implications for higher education institutions. Recommendations include the development of graduate employability measures that record multiple employments and the refinement of employability models. The authors challenge higher education institutions to place the development of self and career at the core of every program

Multilingual gendered identities: female undergraduate students in London talk about heritage languages

In this paper I explore how a group of female university students, mostly British Asian and in their late teens and early twenties, perform femininities in talk about heritage languages. I argue that analysis of this talk reveals ways in which the participants enact ‘culturally intelligible’ gendered subject positions. This frequently involves negotiating the norms of ‘heteronormativity’, constituting femininity in terms of marriage, motherhood and maintenance of heritage culture and language, and ‘girl power’, constituting femininity in terms of youth, sassiness, glamour and individualism. For these young women, I ask whether higher education can become a site in which they have the opportunities to explore these identifications and examine other ways of imagining the self and what their stories suggest about ‘doing being’ a young British Asian woman in London