The cost and cost-effectiveness of alternative strategies to expand treatment to HIV-positive South Africans: scale economies and outreach costs

This repository item contains a single issue of the Health and Development Discussion Papers, an informal working paper series that began publishing in 2002 by the Boston University Center for Global Health and Development. It is intended to help the Center and individual authors to disseminate work that is being prepared for journal publication or that is not appropriate for journal publication but might still have value to readers.The South African government is currently discussing various alternative approaches to the further expansion of antiretroviral treatment (ART) in public-sector facilities. We used the EMOD-HIV model, a HIV transmission model which projects South African HIV incidence and prevalence and ARV treatment by age-group for alternative combinations of treatment eligibility criteria and testing, to generate 12 epidemiological scenarios. Using data from our own bottom-up cost analyses in South Africa, we separate outpatient cost into nonscale- dependent costs (drugs and laboratory tests) and scale-dependent cost (staff, space, equipment and overheads) and model the cost of production according to the expected future number and size of clinics. On the demand side, we include the cost of creating and sustaining the projected incremental demand for testing and treatment. Previous research with EMOD-HIV has shown that more vigorous recruitment of patients with CD4 counts less than 350 is an advantageous policy over a five-year horizon. Over 20 years, however, the model assumption that a person on treatment is 92% less infectious improves the cost-effectiveness of higher eligibility thresholds, averting HIV infections for between $1,700 and$2,800, while more vigorous expansion under the current guidelines would cost more than $7,500 per incremental HIV infection averted. Based on analysis of the sensitivity of the results to 1,728 alternative parameter combinations at each of four discount rates, we conclude that better knowledge of the behavioral elasticities could reduce the uncertainty of cost estimates by a factor of 4 to 10

The Brownfields Phenomenon: Much Ado about Something or the Timing of the Shrewd?

This paper provides an overview of the cleanup and redevelopment of contaminated properties known as “brownfields.” It has three principal parts. First, we introduce the brownfields phenomenon and its drivers, drawing on the body of available empirical evidence to discuss characteristics of individual brownfield redevelopment projects. Second, we present findings from a recent study we have conducted that examines the relative attractiveness to private developers of public interventions to promote brownfields redevelopment. Third, we briefly summarize some of the problems with brownfields development and policy and propose an approach to promote wider societal benefits of brownfields development. We conclude with several broad questions about brownfields policy and practice.brownfields, contamination, economic development, infill

Tackling Textbooks of the Times: The Telling Truth About Race in Textbooks from 1945-1970

As a key classroom tool, textbooks offer concrete insights from the past. In 1944, Gunnar Myrdal’s study An American Dilemma: The Negro Problem and Modern Democracy, convinced Americans that the issue of American prejudice and racism could be eradicated using education. In response, intellectuals, educators, and activists moved the front of the battle against racial prejudice and discrimination to the classrooms and textbooks. In the Cold War geopolitical context and the American Civil Rights Movement, the approach to teaching race shifted rapidly and dramatically between 1945 and 1970. This thesis examines how textbooks shifted due to these influences to show how intellectuals, educators, and activists shaped their attempts to solve the American dilemma. However, textbooks are not without their own limitations. In the twenty-five years after World War II, textbook publishing and adoption rates were generally slow and new classroom sets were expensive. The textbook lag was acknowledged and somewhat amended through supplemental teaching material. Nevertheless, textbooks limited the success of education as the method in which to solve racial prejudice. An evaluation of the shifts textbooks did display, represents that the role of education in solving social issues is possible. There is hope for the future of education and textbooks, as technology continues to diminish the inherent limitations of textbooks

Trends in population health in an era of increasing longevity

In Sweden, the number of older adults over the age of 85 increased by 75% since 1990 while the number of centenarians has almost quadrupled. Rapid population ageing is a global phenomenon and projected to continue in almost all countries worldwide, Sweden among them, throughout the 21st century. Since old age is generally associated with a high risk of disease and care-dependency, population ageing often evokes concern. However, population ageing is accompanied by changing disease patterns and by a changing sociodemographic population composition and its consequences for public health are thus not straightforward. Highlighting heterogeneity in the population, this thesis aims to present changing mortality and morbidity patterns among older adults in Sweden during the past three decades. I thereby aim to increase the understanding of changing health and geriatric care needs in an ageing society and to explore how a changing population structure affects population health. The thesis is based on a linkage of several nationwide population registers covering all individuals over the age of 60 in Sweden. It integrates both epidemiological and demographical methods and focuses on some of the most common and severe diseases in old age. While Studies I and II additionally include cardiovascular diseases and cancer, the two most common causes of death globally, Studies III to V focus on hip fractures – an enormous public health issue in Sweden, where lifetime risks exceed 20% among women and 10% among men. In Studies I and II, we use life table methods and decomposition techniques to show that remaining life expectancy in old age has increased faster among men and women with a history of cardiovascular diseases and cancer than it has in the general population. Almost half of the total increase in Swedish life expectancy during 1994 to 2016 can be attributed to improved survival among individuals with a history of myocardial infarction alone. As a result of longer life expectancy, disease prevalence increased. These two processes had counteracting influences on the development of life expectancy, but at least for cardiovascular diseases, the positive impact of improved survival far outweighed the negative one caused by rising disease prevalence. In contrast to all other diseases, life expectancy did not increase among older adults with a history of hip fracture. In Study III, we found the Swedish Hip Fracture Quality Register and National Patient Register to be suitable to study nationwide hip fracture trends. Nevertheless, some patients dying shortly after their fracture were not included in the quality register, indicating a selection towards healthier patients. We further derive algorithms to operationalize first and recurrent hip fractures in the National Patient Register. Study IV shows that the age-standardized incidence of first and recurrent hip fracture has declined between 1998 and 2017 in the total population and in population strata defined by gender, education, comorbidity level, and birth country. Nevertheless, 20% of women and 30% of men died within one year of their first hip fracture and these risks remained essentially unchanged. The lack of mortality improvements could at least partly be attributed to rising comorbidity levels among hip fracture patients. Study V demonstrates that hip fractures have an immediate negative impact on care trajectories of older patients. However, already before their fracture, older adults who sustained a hip fracture were frailer and more likely to receive geriatric care than the general older population. Our comparison to a health-matched control group suggests that the increase in care use among hip fracture patients might have also occurred in absence of the fracture, even if somewhat later. In conclusion, life expectancy increases were not limited to the healthy part of the population. Rising life expectancy can at least partly be attributed to tertiary prevention enabling older adults who experienced severe diseases to survive longer. However, trends were not uniform across diseases. While we observed rising life expectancy among older adults with a history of cardiovascular diseases and cancer, hip fracture patients – and especially men – remain a vulnerable population group with increasing comorbidity levels and high mortality risk. Our findings also emphasize the importance of selection processes and the choice of adequate comparison groups when examining the consequences of disease

Assessment of Poly(ADP-ribose) Polymerase1 (PARP1) expression and activity in cells purified from blood and milk of dairy cattle

Poly(ADP-ribosyl)ation (PAR) is a post-translational protein modification catalysed by enzyme member of the poly(ADP-ribose) polymerases (PARPs) family. The activation of several PARPs is triggered by DNA strand breakage and the main PARP enzyme involved in this process is PARP1. Besides its involvement in DNA repair, PARP1 is involved in several cellular processes including transcription, epigenetics, chromatin re-modelling as well as in the maintenance of genomic stability. Moreover, several studies in human and animal models showed PARP1 activation in various inflammatory disorders. The aims of the study were (1) to characterize PARP1 expression in bovine peripheral blood mononuclear cells (PBMC) and (2) to evaluate PAR levels as a potential inflammatory marker in cells isolated from blood and milk samples following different types of infection, including mastitis. Our results show that (i) bovine PBMC express PARP1; (ii) lymphocytes exhibit higher expression of PARP1 than monocytes; (iii) PARP1 and PAR levels were higher in circulating PBMCs of infected cows; (iv) PAR levels were higher in cells isolated from milk with higher Somatic Cell Counts (SCC > 100,000 cells/mL) than in cells from milk with low SCCs. In conclusion, these findings suggest that PARP1 is activated during mastitis, which may prove to be a useful biomarker of mastitis

Trajectory of collections and museography of the brazilian industrial exhibitions: from national to international exhibitions in the XIX century

Esta investigação visa analisar e detalhar informações sobre a apresentação de coleções industriais nas Exposições Nacionais Brasileiras e Universais do século XIX. A primeira participação oficial brasileira numa Exposição Universal foi em 1862 em Londres. Com esta participação, o país começou a preparar exposições nacionais para organizar e selecionar coleções de produtos a serem apresentados nas Exposições Internacionais. De 1861 a 1889, o Brasil organizou cinco Exposições Nacionais. Explorando estes eventos, e através da análise das descrições, documentos iconográficos, a análise do enquadramento histórico, e a circulação do conhecimento trocado, é possível investigar as coleções industriais que foram apresentadas nas Exposições Nacionais e Internacionais e a museografia utilizada nestas apresentações. O nosso objetivo é também identificar a existência de objetos apresentados nas Exposições que hoje se encontram nos museus brasileiros; Trajectory of collections and Museography of the Brazilian Industrial Exhibitions: from National to International Exhibitions in the XIX century Abstract: This research aims to analyse and detail information about the presentation of industrial collections in the Universal and Brazilian National Expositions in the 19th century. The first Brazilian official participation in a Universal Exhibition was in 1862 in London. With this participation, the country began to prepare national exhibitions to organise and select collections of products to be presented in the International Exhibitions. From 1861 to 1889, Brazil organised five National Exhibitions. Exploring these events, and through analysing the descriptions, iconography documents, the analysis of the historical framework, and the circulation of knowledge exchanged, it is possible to investigate the industrial collections that were presented in the National and International Exhibitions and the museography used in these presentations. We also aim to identify the existence of objects presented in the Exhibitions that are now found in Brazilian museums; Trajectoire des collections et muséographie des expositions industrielles brésiliennes:des expositions nationales aux expositions internationales au XIXe siècle Résumé: Cette recherche vise à analyser et à détailler les informations relatives à la présentation des collections industrielles dans les Expositions universelles et nationales brésiliennes du XIXe siècle. La première participation officielle du Brésil à une exposition universelle a eu lieu en 1862 à Londres. Avec cette participation, le pays a commencé à préparer des expositions nationales pour organiser et sélectionner des collections de produits à présenter dans les expositions internationales. De 1861 à 1889, le Brésil a organisé cinq expositions nationales. En explorant ces événements, et à travers l'analyse des descriptions, des documents iconographiques, de l'analyse du cadre historique et de la circulation des connaissances échangées, il est possible d'étudier les collections industrielles qui ont été présentées dans les Expositions nationales et internationales et la muséographie utilisée dans ces présentations. Nous cherchons également à identifier l'existence d'objets présentés dans les expositions qui se trouvent aujourd'hui dans les musées brésiliens

Trafficking of endoplasmic reticulum-retained recombinant proteins is unpredictable in Arabidopsis thaliana

A wide variety of recombinant proteins has been produced in the dicot model plant, Arabidopsis thaliana. Many of these proteins are targeted for secretion by means of an N-terminal endoplasmic reticulum (ER) signal peptide. In addition, they can also be designed for ER retention by adding a C-terminal H/KDEL-tag. Despite extensive knowledge of the protein trafficking pathways, the final protein destination, especially of such H/KDEL-tagged recombinant proteins, is unpredictable. In this respect, glycoproteins are ideal study objects. Microscopy experiments reveal their deposition pattern and characterization of their N-glycans aids in elucidating the trafficking. Here, we combine microscopy and N-glycosylation data generated in Arabidopsis leaves and seeds, and highlight the lack of a decent understanding of heterologous protein trafficking

Midwives’ engagement in smoking- and alcohol-prevention in prenatal care before and after the introduction of practice guidelines in Switzerland : comparison of survey findings from 2008 and 2018

Background: Evidence suggests that cigarette smoking and alcohol consumption during pregnancy negatively impacts fetal health. Health agencies across countries have developed specific guidelines for health professionals in perinatal care to strengthen their role in smoking and alcohol use prevention. One such example is the “Guideline on Screening and Counselling for prevention of cigarette smoking and alcohol consumption before, during, and after pregnancy” introduced by the Swiss Midwives Association in 2011. The current study assesses the changes in midwives’ engagement in smoking and alcohol use prevention before (2008) and after the introduction of the Guideline (2018). Further, the current study examines differences across regions (German vs. French speaking regions), graduation years (before and after the introduction of the Guideline) and different work settings (hospital vs. self-employed). Methods: Survey data were collected in 2008 (n = 366) and in 2018 (n = 459). Differences in how midwives engaged in smoking and alcohol use prevention between 2008 and 2018 were assessed with chi-square tests, as were differences across German and French speaking regions, graduation years (before and after the introduction of the Guideline) and across different work settings (working in hospitals or as self-employed). Results: An increase in midwives’ awareness of the risks of consuming even small quantities of cigarettes and alcohol for the unborn child between 2008 and 2018 is evident. Explaining the risks to pregnant women who smoke or use alcohol remained the most frequently reported prevention strategy. However, engagement with more extensive smoking and alcohol use preventive strategies across the whole course of pregnancy, such as assisting women in the elaboration of a plan to stop smoking/alcohol use, remained limited. Conclusions: Seven years after its introduction, the effectiveness of the Guideline in increasing midwives’ engagement in smoking and alcohol use prevention appears limited despite midwives’ increased awareness