The economics in 'Global Health 2035': a sensitivity analysis of the value of a life year estimates

In “Global health 2035: a world converging within a generation,” The Lancet Commission on Investing in Health (CIH) adds the value of increased life expectancy to the value of growth in gross domestic product (GDP) when assessing national well-being. To value changes in life expectancy, the CIH relies on several strong assumptions to bridge gaps in the empirical research. It finds that the value of a life year (VLY) averages 2.3 times GDP per capita for low- and middle-income countries (LMICs) assuming the changes in life expectancy they experienced from 2000 to 2011 are permanent. We investigate the sensitivity of this estimate to the underlying assumptions, including the effects of income, age, and life expectancy, and the sequencing of the calculations. We find that reasonable alternative assumptions regarding the effects of income, age, and life expectancy may reduce the VLY estimates to 0.2 to 2.1 times GDP per capita for LMICs. Removing the reduction for young children increases the VLY, while reversing the sequencing of the calculations reduces the VL

Estimation of distribution of childhood diarrhoea, measles, and pneumonia morbidity and mortality by socio-economic group in low-income and middle-income countries

Background Vaccines are one of the most successful interventions in improving population health in low-income and middle-income countries (LMICs). In addition to the direct improvements in health outcomes, we are interested in their distributional effects—that is, whether vaccines promote or reduce health equity across socioeconomic groups. Empirical data on incidence and mortality of vaccine-preventable diseases across socioeconomic groups is not available. Therefore, we developed a method to estimate the distribution of childhood diseases and deaths across income groups and the benefits of three vaccines—for diarrhoea, measles, and pneumonia—in 41 LMICs. Methods For every country and disease (diarrhoea, measles, pneumonia), we estimated the distribution of cases and deaths that would occur in each income quintile had there been no immunisation or treatment programme, using both the prevalence and relative risk of a set of risk and prognostic factors. Building on these baseline estimates, we assessed the effect of three vaccines (first dose of measles vaccine, pneumococcal conjugate vaccine, and rotavirus vaccine) under five scenarios based on sets of quintile-specific immunisation coverage and uptake of disease treatment. Findings Because the prevalence of risk factors is higher in the poorest two quintiles than in the rest of the population, more disease cases and deaths would occur in the poorest two quintiles for all three diseases when vaccines or treatment are unavailable. However, we noted that current immunisation coverage and treatment utilisation rates have resulted in greater inequity in the distribution of cases and deaths. Even if in absolute terms the poorest quintiles benefit more from vaccines, the wealthier two quintiles sees a higher percentage decrease in cases and deaths. Thus, in terms of overall distribution of remaining cases and deaths with vaccine coverage, the poorest quintiles would see a higher comparative burden of disease than they would without vaccine coverage. Country-specific context, including how the baseline risks, immunisation coverage, and treatment utilisation are currently distributed across quintiles, affects how different policies translate to improvements in the distribution of cases and deaths. Interpretation Our analysis highlights several factors, including risk and prognostic factors, and vaccine and treatment coverage that would substantially contribute to the unequal distribution of childhood diseases, and we found that merely ensuring equal access to vaccines will not reduce the health outcomes gap between income quintiles. Such information can inform policies and planning of programmes that aim to improve equitable delivery of healthcare services

Single Photons on Pseudo-Demand from Stored Parametric Down-Conversion

We describe the results of a parametric down-conversion experiment in which the detection of one photon of a pair causes the other photon to be switched into a storage loop. The stored photon can then be switched out of the loop at a later time chosen by the user, providing a single photon for potential use in a variety of quantum information processing applications. Although the stored single photon is only available at periodic time intervals, those times can be chosen to match the cycle time of a quantum computer by using pulsed down-conversion. The potential use of the storage loop as a photonic quantum memory device is also discussed.Comment: 8 pages, 7 Figs., RevTe

Investigation into the cause of spontaneous emulsification of a free steel droplet : validation of the chemical exchange pathway

Small Fe-based droplets have been heated to a molten phase suspended within a slag medium to replicate a partial environment within the basic oxygen furnace (BOF). The confocal scanning laser microscope (CSLM) has been used as a heating platform to interrogate the effect of impurities and their transfer across the metal/slag interface, on the emulsification of the droplet into the slag medium. The samples were then examined through X-ray computer tomography (XCT) giving the mapping of emulsion dispersion in 3D space, calculating the changing of interfacial area between the two materials, and changes of material volume due to material transfer between metal and slag. Null experiments to rule out thermal gradients being the cause of emulsification have been conducted as well as replication of the previously reported study by Assis et al.[1] which has given insights into the mechanism of emulsification. Finally chemical analysis was conducted to discover the transfer of oxygen to be the cause of emulsification, leading to a new study of a system with undergoing oxygen equilibration

Calculated GCFR fuel rod behavior for steady state and transient operation

The Idaho National Engineering Laboratory (INEL) was contracted to review the Preliminary Safety Information Document (PSID) Amendment 10 for Gas-Cooled Fast Reactors (GCFR). As part of this effort the light water reactor codes, FRAPCON-1 and FRAP-T5 were converted to model GCFR fuel rod behavior. The conversion and application of these codes for GCFR analyses is the subject of this paper

Estimating the impact of establishing family housing on the annual risk of HIV infection in South African mining communities

The objective of this study was to determine the HIV related epidemiologic impact of establishing family-style housing in mining communities in South Africa. Modeling sex acts as independent Bernoulli trials, the estimated impact of converting to family housing arrangements on the annual risk of HIV infection is calculated and the differential effects on migrants and their partners is explored. Family housing could reduce HIV transmission among migrants and their partners in South Africa. Given baseline estimates, the predicted net reduction in the annual risk of HIV infection with family housing is 0.0254 and 0.0305 for short- and long-stay couples respectively. A reduction in the annual risk of HIV infection under family housing depends on the proportion of HIV negative concordance among couples. HIV-negative concordance among couples above 22% provides reductions in the annual risk of HIV infection under family housing. The results indicate that family housing could decrease HIV transmission among HIV-negative concordant couples, indicating that this policy alternative should be examined closely to assess its viability and use as a prevention method.

Extended Safety Observations From Denosumab Administration in Postmenopausal Women From the FREEDOM and FREEDOM Extension Trials

Endocrinolog

6 YEARS' DENOSUMAB TREATMENT IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS: FIRST 3 YEARS OF THE FREEDOM EXTENSION

Bone and mineral researc