Methods and Findings: A cost-effectiveness model was developed and applied to three hypothetical cohorts inRwanda: newborns, adolescents, and adult men. Effectiveness was defined as the number of HIV infections averted, and was calculated as the product of the number of people susceptible to HIV infection in the cohort, the HIV incidence rate atdifferentages, and the protective effect of MC; discounted back to the year of circumcision and summed over the life expectancy of the circumcised person. Direct costs were based on interviews with experienced health care providers to determine inputs involved in the procedure (from consumables to staff time) and related prices. Other costs included training, patient counselling, treatment of adverse events, and promotion campaigns, and they were adjusted for the averted lifetime cost of health care (antiretroviral therapy [ART], opportunistic infection [OI], laboratory tests). One-way sensitivity analysis was performed by varying the main inputs of the model, and thresholds were calculated at which each intervention is no longer cost-saving and at which an intervention costs more than one gross domestic product (GDP) per capita per life-year gained. Results: Neonatal MC is less expensive than adolescent and adult MC (US $ 15 instead of US $ 59 per procedure) and is cost-saving (the cost-effectiveness ratio is negative), even though savings from infant circumcision will be realized later in time. The cost per infection averted is US $ 3,932 for adolescent MC and US $ 4,949 for adult MC. Results for infant MC appear robust. Infant MC remains highly cost-effective across a reasonable range of variation in the base case scenario. Adolescent MC is highly cost-effective for the base case scenario but this high cost-effectiveness is not robust to small changes in the input variables. Adult MC is neither cost-saving nor highly cost-effective when considering only the direct benefit for the circumcised man.
Our SMS system was inexpensive. Except for the initial registration message, participants did not incur any costs. Our text messaging software was able to send out thousands of text messages per month at an average total cost of US$25 per month. The initial cost of setting up the system (US$5,000) would not be incurred again in the event of scale-up. Because the system is automated and software-based, neither additional human resourc- es nor new physical infrastructure are needed. The SMS software easily works with different languages, and also works across geographical boundaries, limited only by the extent of mobile phone network coverage. Participant registration into the system took no more than two minutes per participant. Our low-cost intervention could easily be integrated into programs for malecircumcisionin Kenya, and likely in other sub-Saharan African countries. Similar studies using SMS or phone reminders demonstrated financial benefits of using SMS, including cost- effectiveness [15–19].
There are some limitations to this study. HIV, urological problems and adverse events were all rare, and our sample may have been too small to detect differences between the defaulter and non-defaulter groups. However, there is no indication of a difference between the groups and we hypothesize that individuals are defaulting before formal discharge because they are healing well. This should be studied more in the future. Additionally, although we collected information about type of adverse event, information about the severity of adverse events was not collected and should be collected in future studies. Finally, RMH is a national referral hos- pital with different services and infrastructure compared to district hospitals and health centers where this procedure is mostly likely to be scaled. However, as PrePex procedure is performed in a clean environment, with non-physicians and without anesthesia, we expect that outcomes and few complications observed in this study would be replicated in other clinical settings inRwanda and in sub-Saharan Africa.
To determine the relative cost (EIMC unit cost divided by adolescent VMMC unit cost) at which neonatal and adolescent circumcision have the same cost per lifetime HIV infection averted, we used a different analytical approach, separate from DMPPT2.0 but with the same data sources. We created a simple cohort model in which equal numbers of infants and 15-year-olds are circumcised at the same time in 2015. The total HIV infections averted for each cohort, compared to the reference scenario in which MC prevalence remains at baseline levels for each age group, is calculated as follows: for each year in each cohort’s lifetime (until and including age 85), the model adds the age-specific HIV incidence from 2015, multiplied by the effectiveness of VMMC (60%), reduced by the age-specific mortality, and discounted by 3% annually. The initial population size of the EIMC cohort is reduced by the baseline MC preva- lence among adolescents, to account for the fact that when infants are circumcised through the EIMC program, those boys are preempted from being circumcised as adolescents. In other words, EIMC is replacing the baseline circumcisions that would have happened when the boys grew older, so the replacement circumcisions do not count toward the HIV infections averted. The relative unit costat which the cost per HIV infection averted by EIMC is the same as that for adolescent VMMC is given by the cumulative discounted HIV infections averted for the EIMC cohort divided by the cumulative discounted HIV infections averted for the adolescent cohort. For a range of discount rates, investigators calculated how much lower EIMC unit costs would need to be compared to adolescent VMMC unit costs in order to have the same cost per lifetime HIV infection averted.
Three randomized, controlled clinical trials conducted in South Africa, Kenya, and Uganda found that medical circumcisionin men reduced participants’ risk of HIV infection [1–3]. In these studies, men who had been randomly assigned to the circumcision group had a lower (60% in South Africa, 53% in Kenya, and 51% in Uganda) incidence of HIV infection compared with men assigned to the wait list group to be circumcised at the end of the study. In a per protocol analysis, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk of HIV infection compared to those who were not circumcised. In Kenya, efficacy increased to 64% when the follow-up period was extended from 24 to 42 months (Bailey RC, Moses S, Parker CB, Agot K, Maclean I, et al. The protective effect of malecircumcision is sustained for at least 42 months: results from the Kisumu, Kenya trial. XVII International AIDS Conference. Aug. 3–8, 2008. Mexico City, Mexico.). Based on the results of these studies, the World Health Organization (WHO) has recommended that malecircumcision
dine was applied, and the base of the penis was locally narcotized with 1% lidocaine, The PCSD of the selected size was removed from the steri- le pouch, and the adjustment-knob was turned counterclockwise until the glans receiver socket could be removed. Third, the prepuce was clam- ped with 2-3 mosquito forceps and lifted up to place the glans receiver socket on the glans at approximately 30º of incline relative to the dor- sum of penis. Fourth, the lengths of the inner and outer skin were adjusted, and the prepuce was fixed with the forefinger and middle finger of the left hand to remove the mosquito forceps. Fifth, the assistant removed the staple cover from the main body, aligned the glans receiver socket black rib with the main body rib, inserted the glans receiver socket shaft into the main body, and turned the adjustment knob clockwise via a wing nut until it stopped at the right position so that the main body was snug onto the foreskin without cutting it. Regarding stopping at the ri- ght position, the finger can be used to touch the adjustment-knob end, and if it is in the same pla- ne, the metel shaft of glans receicer socket can be turned together with the adjustment-knob Sixth, the yellow safety pin was removed to prepare for holding the PCSD handles and squeezing evenly on both sides. The handle was then pressed to
Despite the size of the sample, this study’ strong point was the methodological care of randomizing the participants, thus eliminating the volunteer bias. The 25% sample loss is high, considering the small number of participants, but it should be noted that it was proportional for the men (1/5) and women (4/15), and can be attributed to the randomization. Furthermore, the results seem to not have been affected by the loss in follow-up, as was demonstrated in comparing the results of the ITT analyses, such as PPA.
The following were calculated: (1) the proportion of men who were circumcised (prevalence), (2) the proportion of men who had heard of MC (awareness), and (3) separately for circumcised and uncircumcised men, the proportions who reported that they would accept MC for themselves, for their male infants (<1 year of age) and their male sons (ages 1-17 years) before being provided educational information on MC. Chi-square tests were used to ascertain statistical significance of associations of each of the above with socio-demographic factors and with attitudes/beliefs regarding MC. Variables (6) assessing beliefs and attitudes towards MC including penile hygiene, pain and pleasure during sex, and ease of contracting HIV/STIs, were dichotomized with circumcised coded as 1 and all the other responses (uncircumcised, no difference, don’t know) coded as 0, before multivariable modeling. This was done because the associations that were observed among responses such as uncircumcised, no difference, and don’t know were very similar. Combining these categories increased interpretability and increased statistical power. Concerns about MC were also dichotomized into any concern or no concern before modeling. Logistic regression was used to ascertain independent associations with awareness and acceptance of MC. Backward selection modeling was used in the adjusted models. Variables with a p-value <0.10 in chi-square analysis were entered into the multivariable logistic regression analyses and retained if p<0.05. The final models for acceptance and knowledge of MC were adjusted for age, income, education, and religion as these were a priori believed to be associated with awareness and acceptance of MC. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated from the regression equations. Data analysis was performed using SAS software version 9.2 (SAS Institute, Cary, NC).
Environmental relative humidity dramatically impacts poultry over all ambient temperatures, especially during heat stress. The ability of air to hold water vapor is not constant and significantly increases with temperature. As environmental relative humidity rises, the bird’s ability to evaporate water declines, and consequently, its body temperature increases (Nääs, 1994; Teeter & Belay, 1996). In order to achieve optimal temperature inside turkey houses under tropical climate conditions, adequate ventilation and fogging systems are required. The use of cooling and ventilation systems affects the thermal environment of poultry houses, and the balance between sensible and latent losses obtained with the use of this equipment is well documented in literature (Sasseville et al., 1988; Nixey & Grey, 1989; Timmons & Hillman, 1993; Aradas et al., 2005). However, there is a lack of scientific information on the response of turkeys exposed to different combinations of temperature and relative humidity.
The cost categories that were most sensitive to MC procedure method were consumable supplies and direct personnel. Other client-oriented (e.g., counseling, STI screening and management) and program running (e.g., vehicles, utilities, and supervision) were insensitive to method of MC. Under the PrePex method of MC, it is necessary to review the client one week after device placement to remove the ring and excise necrotic foreskin. Additional visits may be required for bandage removal or wound healing assessment, though these costs were not included in the analysis. Higher review rates under either method would represent an additional opportunity for risk-reduction counseling, although the public health impact of additional review visits may be minimal [31,32]. Several of our assumptions likely resulted in the underestimation of PMC costs. We used low AE rates for PMC (0.5% and 1%) and included only potential cases of swelling . Studies from other MC devices have detected other common MC-related AEs, including device detachment, wound dehiscence, bleeding, infec- tion, and pain [20,23,33]. Although we assumed that only one size of the device would be required, there are five different adult PrePex ring sizes. Logistical management systems necessary to deliver and maintain more than one device size to various facilities would likely add to the PMC cost . Finally, a recent study found healing time under PMC was approximately two weeks longer than under a standard surgical method  which could potentially lead to increased post-procedure visits and a longer recommended abstinence period.
28 analyses, that muscles at birth are essentially oxidative. The main heat production mechanisms in newborn pigs is shivering thermogenesis and oxidative fiber produce more heat per unit time than other fibers, when used in shivering (Herpin et al. 2002) . Thus, the differences in fiber type induced by changes in energy status reflect changes in the concentration of contractile proteins within specific muscles and hence in the functional properties of these muscles. We can observe in Figure 7 , although the proportion of oxidative MyHC decreases, this proportion still higher than glycolytic MyHC (IIX and IIB) until nearly 60 days to Piau and CrB and 83 days to Com, suggesting that proportion of oxidative fibers is higher until these dates but in decreasing rates. Laffecheteur et al. (1986) found that proportion of fibers type I increased from birth up to 2 months of age and little rate occurred thereafter.
It’s equally fascinating that the obvious concern about the impact of malecircumcision on male-to-female HIV transmission seems to be of no interest to researchers. There are good reasons to expect [2,3]—and empirical evidence for (see “Heterosexual Transmission, Europe versus the United States” at http:⁄⁄www.circumstitions.com/HIV. html#hetero)—the thesis that male genital mutilation causes a signiﬁ cant increase in the rate of male-to-female HIV transmission. The net effect of circumcisionin a given population may be evident in the vastly different rates of HIV infection in the United States and Europe, where routine medical genital surgery on normal, healthy, nonconsenting children is unknown. Although the collateral damage of malecircumcision to women might be prevented by routine female genital mutilation, as shown in this impolitic study , one would hope common sense and decency might preemptively stop a new medical crusade against normal human anatomy. Richard Winkel
This investigation was carried out to study egg traits (weight, specific gravity and eggshell thickness), and neonatal chick parameters (weight, blood, cardiac and lung parameters) from breeder atdifferentages. After hatching, neonatal chicks, male and female, from broiler breeder at three differentages (30, 45 and 60 weeks) were sacrificed and blood (red blood cell number, hematocrit, mean cell volume, blood viscosity, and haemoglobin), cardiac (right ventricle and total ventricle weights, cardiac index) and lung (mean pulmonary pressure, fresh relative lung weight) parameters were measured. No significant differences in eggshell thickness or specific gravity were observed in eggs from the three different breeder age. The incubated eggs and neonatal chicks showed heavier absolute weights with increasing breeder age. Broiler breeder age did not affect blood parameters or cardiac index, but affected right ventricle and total ventricle absolute weights. Red blood cell number and hematocrit were higher and lung weight and lung weight:chick weight index were lower for female neonatal chicks. The findings of this study revealed that breeder age affects neonatal chick parameters such as body weight, heart and lung absolute weights, but not blood parameters.
volunteers) throughout the main randomised controlled trial. There were seven women and two men, aged 26–61 (mean 48) years. Some had taken early retirement, others cared for young children. Their work experience was at varying levels of seniority from a receptionist to a retired head teacher. Five had degree level education. All had well developed social skills and were natural communicators capable of expressing warmth and empathy appropriately. On average, 19 contacts were provided per participant (15 hours), starting about the same time (day 17) as the therapists’ first contacts with the intervention group. Continual training and support for visitors by the visitor monitor ensured protocol adherence and human resource management. Adding in the additional NHS speech and language therapy received by the 18 participants who refused their allocation meant that controls overall received an average total of 23 contacts (visitor plus usual care), almost identical to the average of 22 contacts received by those in the intervention arm. Most visitors prepared a rough plan for each visit based on what they picked up about a participant’s interests, family, and job, but generally let the sessions be patient led. The activity that occurred most frequently was, not surprisingly, conversation. Other activities occurred, but far less often (such as reading to the participant; games; television, radio, music; and “other,”
use of HRmax prediction equations; some studies show a good correlation between measured and predicted HRmax, while in others this correlation is weak. This may be partly attributed to variations in experimental conditions, such as the type of population, small sample size, and different evaluation protocols, equipment for analysis, and ergometer used.
The study was conducted at the Experimental Farm of Santa Rita/EPAMIG, in the municipality of Prudente de Morais, state of Minas Gerais, Brazil, located at 19°27’15” S and 44°09’11” W, and altitude of 732 m. According to Köppen’s classification, the climate of the region is type Aw, with dry season from May to October and wet season from November to April. The climate data were recorded during the growth of the signal grass (from the beginning of March until April 20), which occurred soon after the corn harvest. The accumulated rainfall was 246 mm, the average maximum temperature was 29.3 °C, and the average minimum temperature was 17.9 °C.
This study has some limitations. The first limitation lies in its use of the Sullivan method which uses the observed prevalence resulting from the past incidence and mortality experience of each cohort in the survey rather than the current incidence rates [22,29]. Thus, it might not be able to reflect current morbidity patterns. However, the Sullivan method is the most often used because it requires only cross-sectional data and period life tables which are widely avail- able [22,29]. Moreover it has been shown to provide unbiased estimates of health expectancy if the transition rates are stable and smooth over time . The second limitation is that health examination surveys may underestimate the prevalence of mobility limitation as people with severe illness or mobility problems (e.g. hemiplegic conditions) may not have been able to par- ticipate. Further, regarding the self-report of mobility performance, it is not clear in the survey whether participants were asked to report their actual performance to do these functions or to judge their capacity. Basically, the level of dependence does not correspond to what they think they can do but to what they actually do . Finally, institutionalized people were not included as there are no publicly available data by age and sex. Nevertheless, in 2010 there were approximately 7,000 institutionalized elderly (combining those in nursing homes and prisons), representing less than 0.1 percent of the total older population , so this is unlikely to have had a major effect on our estimates.
Traditionally meat quality is either eating quality or processing quality, therefore quality is directly associated with usage and is a multifaceted concept (Webb et al., 2005). Lawrie, (1991) stated that meat eating quality involves five attributes namely, colour, water holding capacity, tenderness, juiciness and flavour. All attributes are influenced by breed, sex, age, anatomical location, exercise, nutrition and internal variability. Color is an important criterion of raw or cooked meat and meat products. It reflects the proper composition of the products, particularly in relation of meat to other compounds, freshness of raw materials, texture, taste and proper conditions of storage (Klak et al., 2001; Alberti et al., 2002). Water holding capacity is the ability of meat to retain its own or added water during application of external forces such as cutting, heating, grinding, or pressing (Judge et al., 1989) . Cooking loss is one of the most important properties of sausage products as it is related to water holding capacity. There is variation in water holding capacity among different types of meat from different animal and muscles (Lawrie, 1991). Mukasa, (1981) defined texture of meat as the sensory manifestation of the structure of the meat and the manner in which the structure reacts to the force applied during biting. Simela et al., (2003) stated that meat tenderness and flavor are the most important components that determine meat quality. The Objective of this study is:
RESUMO. As determinações das frações proteicas e características de fermentação ruminal de genótipos de milheto são de fundamental importância, pois geram informações relativas ao valor nutritivo do alimento e direcionam os programas de melhoramento genético a serem utilizadas na dieta de ruminantes. Diante disso, objetivou-se determinar as taxas de digestão das frações de proteína, degradabilidade ruminal da matéria seca e digestibilidade “in vitro” da matéria seca das silagens dos genótipos de milheto produzidas em diferentes épocas de corte. O experimento foi conduzido no Campus da Faculdade de Agronomia da Universidade de Rio Verde e Instituto Federal Goiano, Campus Rio Verde. O delineamento experimental utilizado foi de blocos ao acaso, com quatro repetições, em esquema fatorial 5 x 3, sendo, cinco cultivares de milheto: ARD 500, ADR 7010, LAB 0730, LAB 0731 e LAB 0732 e três idades de cortes: 57, 65 e 73 dias após a semeadura (DAS). Os resultados mostraram que as silagens produzidas por milheto, independente do genótipo, podem ser consideradas de boa qualidade. Por se tratar de materiais precoces a melhor idade que proporcionou melhor qualidade da silagem desses materiais, foi quando os materiais foram colhidos aos 57 DAS, em que proporcionaram maiores frações A, menores frações C e elevadas degradabilidade e digestibilidade.