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

Project Testbed: Argument Mapping and Deliberation Analytics

One key goal of the Catalyst project was to design metrics that could capture and represent aspects of the conversation’s structural quality, to assist harvesters and moderators. Many such metrics, alerts and visualizations were developed in the course of the project, but initial user testing has shown that users find it difficult to interpret abstract signals. Following that, we have both introduced new analytics that we felt could be more directly useful, and improved the representation of existing ones. We evaluated their usefulness in a smaller conversation and in experimental settings

Including widespread geometry formats in semantic graphs using RDF literals

The exchange of building data involves both geometric and non-geometric data. A promising Linked Data approach is to embed data from existing geometry formats inside Resource Description Framework (RDF) literals. Based on a study of relevant specifications and related work, this toolset-independent approach was found suitable for the exchange of geometric construction data. To implement the approach in practice, the File Ontology for Geometry formats (FOG) and accompanying modelling method is developed. In a proof-of-concept web application that uses FOG, is demonstrated how geometry descriptions of different existing formats are automatically recognised and parsed

Thermal decoherence of a nonequilibrium polariton fluid

Exciton-polaritons constitute a unique realization of a quantum fluid interacting with its environment. Using Selenide based microcavities, we exploit this feature to warm up a polariton condensate in a controlled way and monitor its spatial coherence. We determine directly the amount of heat picked up by the condensate by measuring the phonon-polariton scattering rate and comparing it with the loss rate. We find that upon increasing the heating rate, the spatial coherence length decreases markedly, while localized phase structures vanish, in good agreement with a stochastic mean field theory. From the thermodynamical point-of-view, this regime is unique as it involves a nonequilibrium quantum fluid with no well-defined temperature, but which is nevertheless able to pick up heat with dramatic effects on the order parameter.Comment: 6 pages, 4 figure

Specyfika komunikatu reklamowego

Udostępnienie publikacji Wydawnictwa Uniwersytetu Łódzkiego finansowane w ramach projektu „Doskonałość naukowa kluczem do doskonałości kształcenia”. Projekt realizowany jest ze środków Europejskiego Funduszu Społecznego w ramach Programu Operacyjnego Wiedza Edukacja Rozwój; nr umowy: POWER.03.05.00-00-Z092/17-00

A psychoanalytic concept illustrated: Will, must, may, can — revisiting the survival function of primitive omnipotence

The author explores the linear thread connecting the theory of Freud and Klein, in terms of the central significance of the duality of the life and death instinct and the capacity of the ego to tolerate contact with internal and external reality. Theoretical questions raised by later authors, informed by clinical work with children who have suffered deprivation and trauma in infancy, are then considered. Theoretical ideas are illustrated with reference to observational material of a little boy who suffered deprivation and trauma in infancy. He was first observed in the middle of his first year of life while he was living in foster care, and then later at the age of two years and three months, when he had been living with his adoptive parents for more than a year