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

Emergence of canonical ensembles from pure quantum states

We consider a system weakly interacting with a bath as a thermodynamic setting to establish a quantum foundation of statistical physics. It is shown that even if the composite system is initially in an arbitrary nonequilibrium pure quantum state, the unitary dynamics of a generic weak interaction almost always drives the subsystem into the canonical ensemble, in the usual sense of typicality. A crucial step is taken by assuming that the matrix elements of the interaction Hamiltonian have random phases, while their amplitudes are left unrestricted

The Role of Kemeny's Constant in Properties of Markov Chains

In a finite state irreducible Markov chain with stationary probabilities \pi_i and mean first passage times m_(ij) (mean recurrence time when i = j) it was first shown by Kemeny and Snell (1960) that \sum_j \pi_j m_(ij) is a constant K, not depending on i. This constant has since become known as Kemeny's constant. A variety of techniques for finding expressions and various bounds for K are derived. The main interpretation focuses on its role as the expected time to mixing in a Markov chain. Various applications are considered including perturbation results, mixing on directed graphs and its relation to the Kirchhoff index of regular graphs.Comment: 13 page

Maximal-entropy random walk unifies centrality measures

In this paper analogies between different (dis)similarity matrices are derived. These matrices, which are connected to path enumeration and random walks, are used in community detection methods or in computation of centrality measures for complex networks. The focus is on a number of known centrality measures, which inherit the connections established for similarity matrices. These measures are based on the principal eigenvector of the adjacency matrix, path enumeration, as well as on the stationary state, stochastic matrix or mean first-passage times of a random walk. Particular attention is paid to the maximal-entropy random walk, which serves as a very distinct alternative to the ordinary random walk used in network analysis. The various importance measures, defined both with the use of ordinary random walk and the maximal-entropy random walk, are compared numerically on a set of benchmark graphs. It is shown that groups of centrality measures defined with the two random walks cluster into two separate families. In particular, the group of centralities for the maximal-entropy random walk, connected to the eigenvector centrality and path enumeration, is strongly distinct from all the other measures and produces largely equivalent results.Comment: 7 pages, 2 figure

The Distribution of Mixing Times in Markov Chains

The distribution of the "mixing time" or the "time to stationarity" in a discrete time irreducible Markov chain, starting in state i, can be defined as the number of trials to reach a state sampled from the stationary distribution of the Markov chain. Expressions for the probability generating function, and hence the probability distribution of the mixing time starting in state i are derived and special cases explored. This extends the results of the author regarding the expected time to mixing [J.J. Hunter, Mixing times with applications to perturbed Markov chains, Linear Algebra Appl. 417 (2006) 108-123], and the variance of the times to mixing, [J.J. Hunter, Variances of first passage times in a Markov chain with applications to mixing times, Linear Algebra Appl. 429 (2008) 1135-1162]. Some new results for the distribution of recurrence and first passage times in three-state Markov chain are also presented.Comment: 24 page

Fiber-Based Measurement of Bow-Shock Spectra for Reentry Flight Testing

We demonstrated a fiber-based approach for obtaining optical spectra of a glowing bow shock in a high-enthalpy air flow. The work was performed in a ground test with the NASA Ames Aerodynamic Heating Facility (AHF) that is used for atmospheric reentry simulation. The method uses a commercial fiber optic that is embedded in the nose of an ablating bluntbody model and provides a line-of-sight view in the streamwise direction - directly upstream into the hot post-shock gas flow. Both phenolic impregnated carbon ablator (PICA) and phenolic carbon (PhenCarb 28) materials were used as thermal protection systems. Results show that the fibers survive the intense heat and operate sufficiently well during the first several seconds of a typical AHF run (20 MJ/kg). This approach allowed the acquisition of optical spectra, enabling a Boltzmann-based electronic excitation temperature measurement from Cu atom impurities (averaged over a line-of-sight through the gas cap, with a 0.04 sec integration time)

Effectiveness of an HIV Prevention Program for Women Visiting Their Incarcerated Partners: The HOME Project

Having an incarcerated partner presents a unique HIV risk for women, particularly low-income women of color. We developed a population-specific risk reduction intervention for women visiting men in prison that was peer educator-based and included individual and community-level intervention components. Women who were assessed prior to the intervention period had a positive association between the number of unprotected penetrative intercourse (UPI) episodes prior to their partners’ incarceration and the number of UPI episodes following partners’ release from prison. However, this association was negated among women assessed during the intervention. Intervention participants also were more likely to be tested for HIV, to have partners who got tested, and to talk with their partners about significantly more HIV-related topics. Conducting intervention and evaluation activities with women visiting incarcerated men is feasible and is a useful model for reaching more at-risk women

Fixation time in evolutionary graphs: A mean-field approach

Using an analytical method we calculate average conditional fixation time of mutants in a general graph-structured population of two types of species. The method is based on Markov chains and uses a mean-field approximation to calculate the corresponding transition matrix. Analytical results are compared with the results of simulation of the Moran process on a number of network structures

A Vision of Quantitative Imaging Technology for Validation of Advanced Flight Technologies

Flight-testing is traditionally an expensive but critical element in the development and ultimate validation and certification of technologies destined for future operational capabilities. Measurements obtained in relevant flight environments also provide unique opportunities to observe flow phenomenon that are often beyond the capabilities of ground testing facilities and computational tools to simulate or duplicate. However, the challenges of minimizing vehicle weight and internal complexity as well as instrumentation bandwidth limitations often restrict the ability to make high-density, in-situ measurements with discrete sensors. Remote imaging offers a potential opportunity to noninvasively obtain such flight data in a complementary fashion. The NASA Hypersonic Thermodynamic Infrared Measurements Project has demonstrated such a capability to obtain calibrated thermal imagery on a hypersonic vehicle in flight. Through the application of existing and accessible technologies, the acreage surface temperature of the Shuttle lower surface was measured during reentry. Future hypersonic cruise vehicles, launcher configurations and reentry vehicles will, however, challenge current remote imaging capability. As NASA embarks on the design and deployment of a new Space Launch System architecture for access beyond earth orbit (and the commercial sector focused on low earth orbit), an opportunity exists to implement an imagery system and its supporting infrastructure that provides sufficient flexibility to incorporate changing technology to address the future needs of the flight test community. A long term vision is offered that supports the application of advanced multi-waveband sensing technology to aid in the development of future aerospace systems and critical technologies to enable highly responsive vehicle operations across the aerospace continuum, spanning launch, reusable space access and global reach. Motivations for development of an Agency level imagery-based measurement capability to support cross cutting applications that span the Agency mission directorates as well as meeting potential needs of the commercial sector and national interests of the Intelligence, Surveillance and Reconnaissance community are explored. A recommendation is made for an assessment study to baseline current imaging technology including the identification of future mission requirements. Development of requirements fostered by the applications suggested in this paper would be used to identify technology gaps and direct roadmapping for implementation of an affordable and sustainable next generation sensor/platform system

Fixation, transient landscape and diffusion's dilemma in stochastic evolutionary game dynamics

Agent-based stochastic models for finite populations have recently received much attention in the game theory of evolutionary dynamics. Both the ultimate fixation and the pre-fixation transient behavior are important to a full understanding of the dynamics. In this paper, we study the transient dynamics of the well-mixed Moran process through constructing a landscape function. It is shown that the landscape playing a central theoretical "device" that integrates several lines of inquiries: the stable behavior of the replicator dynamics, the long-time fixation, and continuous diffusion approximation associated with asymptotically large population. Several issues relating to the transient dynamics are discussed: (i) multiple time scales phenomenon associated with intra- and inter-attractoral dynamics; (ii) discontinuous transition in stochastically stationary process akin to Maxwell construction in equilibrium statistical physics; and (iii) the dilemma diffusion approximation facing as a continuous approximation of the discrete evolutionary dynamics. It is found that rare events with exponentially small probabilities, corresponding to the uphill movements and barrier crossing in the landscape with multiple wells that are made possible by strong nonlinear dynamics, plays an important role in understanding the origin of the complexity in evolutionary, nonlinear biological systems.Comment: 34 pages, 4 figure