Costs and cost-effectiveness of alternative tuberculosis management strategies in South Africa - Implications for policy

Objective. To conduct an economic analysis of the Hlabisa community-based directly observed therapy management strategy for tuberculosis and to project costs of three alternative strategies. Setting. Hlabisa health district, KwaZulu-Natal, South Africa. Methods. An economic analysis comparing the current tuberculosis management strategy in Hlabisa with three alternative strategies (the Hlabisa strategy prior to 1991 based on hospitalisation, the national strategy and sanatorium care) in terms of costs to both health service and patient and of cost-effectiveness. Results. The current Hlabisa strategy was the most cost-effective (R3 799 per patient cured), compared with R98 307 for the strategy used prior to 1991, R9 940 for the national strategy, and R11 145 for sanatorium care, Between 71% and 88% of treatment costs lie with the health service, and hospitalisation (R119 per day) is the most expensive item. Prolonged hospitalisation is extremely expensive, but community care is cheaper (community clinic visit, R28; community health worker visit, R7). The total cost of supervising a patient in the community under the current Hlabisa strategy was R503, equivalent to 4.2 days in hospital, Drug costs (R157) are equivalent to just 1.3 days in hospital. Conclusion. Cost to both health service and patient can be substantially reduced by using community-based directly observed therapy for tuberculosis, a strategy that is cheap and cost-effective in Hlabisa, These findings have important national implications, supporting the goals of the new tuberculosis control programme.5 page(s

Modelling the engineering behaviour of fibrous peat formed due to rapid anthropogenic terrestrialization in Hangzhou, China

This is an accepted manuscript of an article published by Elsevier in Engineering Geology on 21/10/2016, available online: https://doi.org/10.1016/j.enggeo.2016.10.009 The accepted version of the publication may differ from the final published version.Peat is a very variable but normally weak material. While engineering failures involving peat are common, the full diversity of engineering behaviours exhibited by peat has not been well classified due to its large range of possible compositions. This paper presents the behaviour of a fibrous peat which is a fill (made ground) originating from the most recent dredging of the West Lake, a site of cultural and historic importance in China. Given its relatively unique mechanism of deposition, the distinctive characteristics of this peat are presented in comparison to other peats reported in the literature highlighting its unique engineering behaviour. A laboratory study carried out on the peat at Jiangyangfan Eco-park, located in Hangzhou, China identifies that it has its special aspects when compared to other peats. The shearing behaviour of peat can be described using the framework of critical state theory. The most prominent characteristic of the West Lake Peat is that its undrained stress path bends towards the left at the very beginning of shearing which indicates that plastic deformation occurs at very small stress ratios. A constitutive model based on critical state theory for predicting the undrained shear behaviour of this type of peat from low stress to critical state levels is presented. This model also includes several elements of peat behaviour previously reported and it may therefore be applied to a wider range of peat soils

Prevalence of infection with human herpesvirus 8/Kaposi's sarcoma herpesvirus in rural South Africa

Objective. To determine prevalence of infection with human herpesvirus 8 (HHV-8)/Kaposi's sarcoma herpesvirus (KSHV) and to gain some insight into possible transmission dynamics of this novel virus in South Africa. Methods. Stored, anonymous serum from 50 patients with a sexually transmitted disease (STD), 50 adult medical ward patients (25 male, 25 female), and 36 paediatric ward patients in Hlabisa Hospital, KwaZulu-Natal, was screened by enzyme-linked immunosorbent assay (ELISA) for antibodies to the small capsid-related protein encoded by HHV-8/KSHV orf65. Antibodies to the latency-associated nuclear antigen(LANA) were measured by immunofluorescence, and sera that were reactive in the ELISA but negative by immunofluorescence were re-tested by Western blot against the recombinant orf65 protein to exclude nonspecific reactivity. Results. Overall, 47 patients tested positive (34.6%), 76 tested negative (55.9%) and 13 (9.5%) had indeterminate results. Among those wit a definite result, prevalence was similar among males (47.2%) and females (52.8%) and increased in later adulthood (<18 months 37.5%, 19 - 120 months 38.5%, 15 - 34 years 32.1% 35 - 69 years 62.8%). Prevalence was highest among medical patients (58.1%); among those with with an STD it was 31.1% (P = 0.01), and among children it was 22.8% (P = 0.001). When age-adjusted, prevalence among medical patients (23.7%) was similar to that among patients with an STD. Conclusion. Prevalence of HHV-8/KSHV is high in this setting and transmission appears to be occurring in childhood as well as among adults. Larger population-based studies are required to detail the transmission dynamics of HHSV-8/KSHV.4 page(s

Gravity-induced Wannier-Stark ladder in an optical lattice

We discuss the dynamics of ultracold atoms in an optical potential accelerated by gravity. The positions and widths of the Wannier-Stark ladder of resonances are obtained as metastable states. The metastable Wannier-Bloch states oscillate in a single band with the Bloch period. The width of the resonance gives the rate transition to the continuum.Comment: 5 pages + 8 eps figures, submitted to Phys. Rev.

Probing the energy bands of a Bose-Einstein condensate in an optical lattice

We simulate three experimental methods which could be realized in the laboratory to probe the band excitation energies and the momentum distribution of a Bose-Einstein condensate inside an optical lattice. The values of the excitation energies obtained in these different methods agree within the accuracy of the simulation. The meaning of the results in terms of density and phase deformations is tested by studying the relaxation of a phase-modulated condensate towards the ground state.Comment: 5 pages, 5 figure

The Social Climbing Game

The structure of a society depends, to some extent, on the incentives of the individuals they are composed of. We study a stylized model of this interplay, that suggests that the more individuals aim at climbing the social hierarchy, the more society's hierarchy gets strong. Such a dependence is sharp, in the sense that a persistent hierarchical order emerges abruptly when the preference for social status gets larger than a threshold. This phase transition has its origin in the fact that the presence of a well defined hierarchy allows agents to climb it, thus reinforcing it, whereas in a "disordered" society it is harder for agents to find out whom they should connect to in order to become more central. Interestingly, a social order emerges when agents strive harder to climb society and it results in a state of reduced social mobility, as a consequence of ergodicity breaking, where climbing is more difficult.Comment: 14 pages, 9 figure

Relating the Lorentzian and exponential: Fermi's approximation,the Fourier transform and causality

The Fourier transform is often used to connect the Lorentzian energy distribution for resonance scattering to the exponential time dependence for decaying states. However, to apply the Fourier transform, one has to bend the rules of standard quantum mechanics; the Lorentzian energy distribution must be extended to the full real axis $-\infty<E<\infty$ instead of being bounded from below $0\leq E <\infty$ (``Fermi's approximation''). Then the Fourier transform of the extended Lorentzian becomes the exponential, but only for times $t\geq 0$, a time asymmetry which is in conflict with the unitary group time evolution of standard quantum mechanics. Extending the Fourier transform from distributions to generalized vectors, we are led to Gamow kets, which possess a Lorentzian energy distribution with $-\infty<E<\infty$ and have exponential time evolution for $t\geq t_0 =0$ only. This leads to probability predictions that do not violate causality.Comment: 23 pages, no figures, accepted by Phys. Rev.

Squeezing of Atoms in a Pulsed Optical Lattice

We study the process of squeezing of an ensemble of cold atoms in a pulsed optical lattice. The problem is treated both classically and quantum-mechanically under various thermal conditions. We show that a dramatic compression of the atomic density near the minima of the optical potential can be achieved with a proper pulsing of the lattice. Several strategies leading to the enhanced atomic squeezing are suggested, compared and optimized.Comment: Latex, 9 pages, 10 figures, submitted to PR

Reach, recruitment, dose, and intervention fidelity of the GoActive school-based physical activity intervention in the UK: a mixed-methods process evaluation

School-based multi-component physical activity (PA) promotion is advocated; however, research has indicated that a multi-component approach may not always be effective at increasing adolescent PA. Evaluation of the GoActive 12-week multi-component school-based intervention showed no effect on adolescent PA. A mixed-methods process evaluation was embedded to facilitate greater understanding of the results, to elicit subgroup perceptions, and to provide insight into contextual factors influencing intervention implementation. This paper presents the reach, recruitment, dose, and fidelity of GoActive, and identifies challenges to implementation. The process evaluation employed questionnaires (1543 Year 9s), individual interviews (16 Year 9s; 7 facilitators; 9 contact teachers), focus groups (48 Year 9s; 58 mentors), alongside GoActive website analytics and researcher observations. GoActive sessions reached 39.4% of Year 9s. Intervention satisfaction was relatively high for mentors (87.3%) and facilitators (85.7%), but lower for Year 9s (59.5%) and teachers (50%). Intervention fidelity was mixed within and between schools. Mentorship was the most implemented component. Factors potentially contributing to low implementation included ambiguity of the roles subgroups played within intervention delivery, Year 9 engagement, institutional support, and further school-level constraints. Multiple challenges and varying contextual considerations hindered the implementation of GoActive in multiple school sites. Methods to overcome contextual challenges to implementation warrant in-depth consideration and innovative approaches