The Experts below are selected from a list of 113520 Experts worldwide ranked by ideXlab platform
Simon Gregson - One of the best experts on this subject based on the ideXlab platform.
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extended family s and women s roles in safeguarding Orphans education in aids afflicted rural zimbabwe
Social Science & Medicine, 2005Co-Authors: Constance Nyamukapa, Simon GregsonAbstract:The extended family forms the basis for Orphan care and education in sub-Saharan Africa. Initial absence followed by emergence of differentials in primary school enrolment between Orphans and non-Orphans have been attributed to the strength and subsequent HIV/AIDS-induced breakdown of extended family Orphan care arrangements. Yet, few attempts have been made to describe how these arrangements are affected by HIV/AIDS or how they relate to observed patterns of childhood outcomes by sex and Orphan status. We use a combination of quantitative and qualitative data to show that maternal Orphans but not paternal or double Orphans have lower primary school completion rates than non-Orphans in rural Zimbabwe, and that these patterns reflect adaptations and gaps in extended family Orphan care arrangements. Sustained high levels of primary school completion amongst paternal and double Orphans--particularly for girls--result from increased residence in female-headed households and greater access to external resources. Low primary school completion amongst maternal Orphans results from lack of support from fathers and stepmothers and ineligibility for welfare assistance due to residence in higher socio-economic status households. These effects are partially offset by increased assistance from maternal relatives. These findings indicate that programmes should assist maternal Orphans and support women's efforts by reinforcing the roles of extended families and local communities, and by facilitating greater self-sufficiency.
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Orphan prevalence and extended family care in a peri urban community in zimbabwe
Aids Care-psychological and Socio-medical Aspects of Aids\ hiv, 1995Co-Authors: G Foster, Simon Gregson, R Shakespeare, F Chinemana, H Jackson, C Marange, S MashumbaAbstract:An Orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included Orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of Orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-Orphan household heads. The majority of Orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for Orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation ...
Seokhoon Kang - One of the best experts on this subject based on the ideXlab platform.
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enhanced self configuration scheme for a robust zigbee based home automation
IEEE Transactions on Consumer Electronics, 2010Co-Authors: Kwangil Hwang, B J Choi, Seokhoon KangAbstract:In recent, ZigBee is considered as a potential solution for a scalable and flexible home automation systems. However, several constraints of the ZigBee might create node failure or frequent link breakages and thus some nodes in the network might become Orphans. This Orphan problem of ZigBee might bring a big confusion to a home automation environment in which a number of consumer devices are interconnected in the multi-hop manner. Therefore, in this paper, an enhanced self-configuration (ESC) scheme is proposed, which can improve the robustness of the conventional ZigBee-based home automation systems by coping well with Orphan propagation problem and dynamic error environments. Through experiments on real system implementation, it is demonstrated that the ESC is superior to the conventional ZigBee network in terms of delay and robustness.
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enhanced self configuration scheme for a robust zigbee based home automation
IEEE Transactions on Consumer Electronics, 2010Co-Authors: Kwangil Hwang, Byoungjo Choi, Seokhoon KangAbstract:In recent, ZigBee is considered as a potential solution for a scalable and flexible home automation systems. However, several constraints of the ZigBee might create node failure or frequent link breakages and thus some nodes in the network might become Orphans. This Orphan problem of ZigBee might bring a big confusion to a home automation environment in which a number of consumer devices are interconnected in the multi-hop manner. Therefore, in this paper, an enhanced self-configuration (ESC) scheme is proposed, which can improve the robustness of the conventional ZigBee-based home automation systems by coping well with Orphan propagation problem and dynamic error environments. Through experiments on real system implementation, it is demonstrated that the ESC is superior to the conventional ZigBee network in terms of delay and robustness.
Adrian Towse - One of the best experts on this subject based on the ideXlab platform.
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Establishing a reasonable price for an Orphan drug
Cost effectiveness and resource allocation : C E, 2020Co-Authors: Mikel Berdud, Michael Drummond, Adrian TowseAbstract:Background This paper addresses the question of what a reasonable price for an Orphan drug is. The research proposes a way to adjust an established payer/HTA body incremental cost-effectiveness threshold (CET) to take account of differences in patient populations and costs of research and development in order to sustain prices that generate rates of return from investments in developing Orphan drugs that are no greater than the industry average. Methods We investigated the cost of conducting research for Orphan drugs as compared to non-Orphan drugs, as well as patient population sizes targeted by Orphans and non-Orphans. We provided an empirical illustration based on novel drug approvals of Orphan and non-Orphan drugs of the FDA between 2011 and 2015 (N = 182). Results Using, for illustration, the NICE incremental CET (£20 K per QALY) as an anchor and adjusting by R&D costs and expected market revenue, we estimated the adjusted reasonable CET for Orphan drugs to be £39.1 K per QALY at the Orphan population cut-off and £78.3 K per QALY at the Orphan population mid-point. For ultra-Orphan drugs the adjusted CET was £937.1 K. Conclusions We propose one general method for establishing a reasonable price for an Orphan drug, based on the proposition that rates of return for investments in developing Orphan drugs should not be greater than the industry average. More research is required on data and assumptions, but with the data and assumptions we use, we find that in order to secure such a reasonable price for an Orphan drug, the CET for Orphans would need to be higher. This could be one approach for establishing the maximum allowable price society should be willing to pay, although decision-makers may still wish to negotiate a lower price, or refuse to pay such a premium over the value-based price in order to treat these groups of patients.
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establishing a reasonable price for an Orphan drug
Research Papers, 2018Co-Authors: Mikel Berdud, Michael Drummond, Adrian TowseAbstract:The high cost of drugs for rare diseases ('Orphan drugs') has generated considerable debate. While there is debate in the economic literature over whether a premium should be paid for 'rarity', these drugs are reimbursed with high prices in many countries. The question then arises as to what should be a reasonable price for an Orphan drug? The research by OHE authors Mikel Berdud and Adrian Towse, along with Professor Mike Drummond from University of York, addresses that question, based on the proposition that, although society may be willing to sacrifice some health gain overall to make treatments for Orphan diseases available, it would not accept a situation whereby manufacturers of these drugs make higher profits than those manufacturers of drugs for non-Orphan conditions. We propose a way to adjust the established cost-effectiveness thresholds (CETs) by several factors, including, the size of patient populations and the costs of research and development (R&D). Once adjusted, CETs sustain prices that generate rates of return from investments in developing Orphan drugs no greater than the industry average. Authors firstly formally develop a general algebraic expression for the adjustment of CETs based on the proposed concept of reasonable price. Then, such general expression is applied, using actual data, to adjust a CET by the two main factors playing a role - (i) the cost of R&D for Orphan drugs as compared to non-Orphans and, (ii) patient population sizes targeted by Orphans and non-Orphans. Research shows that, on average, the estimated research and development (R&D) cost of an Orphan drug is around the 27% of the cost of a non-Orphan. However, potential market revenue is also lower for Orphan drugs compared to non-Orphans, as the average non-Orphan patient populations were around 80 and 100 patients per 50,000 people for SMC and NICE appraised drugs respectively, which are higher than the cut-off population size (25 patients per 50,000 people) for Orphan designation in the EMA's definition of rare diseases. Using the NICE incremental cost-effectiveness threshold (£20K per QALY) as an illustrative anchor and adjusting by R&D costs and expected market revenue, in the base case scenario the adjusted CET for Orphan drugs is estimated to be £39.3K per QALY at the Orphan population cut-off and £78.5K per QALY at the Orphan population mid-point. For ultra-Orphan drugs (with a patient population size of 1 in 50,000 or lower) the adjusted CET resulted in £938.4K. Based on results, authors conclude that to secure a price for Orphan drugs that enables the manufacturer to achieve a rate of return equivalent to that from non-Orphan drugs, the cost-effectiveness threshold for Orphans and ultra-Orphans would need to be higher. The threshold would also need to increase as the targeted patient population size decreases. It is important to note that the report does not indicate what society should be prepared to pay for an Orphan drug, since this involves important societal judgments about whether some population health in total should be forgone in order to provide funding for treatments for rare conditions and, if so, how much. Rather, the authors' approach is one way of determining the maximum allowable price society should be willing to pay, based on allowing a reasonable rate of return.
William M. Tierney - One of the best experts on this subject based on the ideXlab platform.
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Outcomes of HIV-infected Orphaned and non-Orphaned children on antiretroviral therapy in western Kenya.
Journal of acquired immune deficiency syndromes (1999), 2006Co-Authors: Winstone M. Nyandiko, Samuel Ayaya, Esther Clyde Nabakwe, Constance Tenge, John E. Sidle, Constantin T. Yiannoutsos, Beverly S. Musick, Kara Wools-kaloustian, William M. TierneyAbstract:The objectives were to determine outcome differences between Orphaned and non-Orphaned children receiving antiretroviral therapy (ART). Design: Retrospective review of prospectively recorded electronic data. Setting: Nine HIV clinics in western Kenya. Population: 279 children on ART enrolled between August 2002 and February 2005. Main Measures: Orphan status CD4% sex- and age-adjusted height (HAZ) and weight (WAZ) z scores ART adherence mortality. Median follow-up was 34 months. Cohort included 51% males and 54% Orphans. At ART initiation (baseline) 71% of children had CDC clinical stage B or C disease. Median CD4% was 9% and increased dramatically the first 30 weeks of therapy then leveled off. Parents and guardians reported perfect adherence at every visit for 75% of children. Adherence and Orphan status were not significantly associated with CD4% response. Adjusted for baseline age follow-up was significantly shorter among Orphaned children (median 33 vs. 41 weeks P = 0.096). One-year mortality was 7.1% for Orphaned and 6.6% for non-Orphaned children (P = 0.836). HAZ and WAZ were significantly below norm in both groups. With ART HAZ remained stable while WAZ tended to increase toward the norm especially among non-Orphans. Orphans showed identical weight gains as non-Orphans the first 70 weeks after start of ART but experienced reductions afterwards. Good ART adherence is possible in western rural Kenya. ART for HIV-infected children produced substantial and sustainable CD4% improvement. Orphan status was not associated with worse short-term outcomes but may be a factor for long-term therapy response. ART alone may not be sufficient to reverse significant developmental lags in the HIV-positive pediatric population. (authors)
Cary A Johnson - One of the best experts on this subject based on the ideXlab platform.
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barriers and incentives to Orphan care in a time of aids and economic crisis
Journal of Hiv\ aids Prevention in Children & Youth, 2008Co-Authors: Brian H Howard, Carl V Phillips, Nelia Matinhure, Karen J Goodman, Sheryl A Mccurdy, Cary A JohnsonAbstract:ABSTRACT Background: Africa is in an Orphan-care crisis. In Zimbabwe, where one-fourth of adults are HIV-positive and one-fifth of children are Orphans, AIDS and economic decline are straining society's ability to care for Orphans within their extended families. Lack of stable care is putting thousands of children at heightened risk of malnourishment, emotional underdevelopment, illiteracy, poverty, sexual exploitation, and HIV infection, endangering the future health of the society they are expected to sustain. Methods: To explore barriers and possible incentives to Orphan care, a quantitative cross-sectional survey in rural eastern Zimbabwe asked 371 adults caring for children, including 212 caring for double Orphans, about their well-being, needs, resources, and perceptions and experiences of Orphan care. Results: Survey responses indicate that: (1) foster caregivers are disproportionately female, older, poor, and without a spouse; (2) 98% of non-foster caregivers are willing to foster Orphans, many fr...
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barriers and incentives to Orphan care in a time of aids and economic crisis a cross sectional survey of caregivers in rural zimbabwe
BMC Public Health, 2006Co-Authors: Brian H Howard, Carl V Phillips, Nelia Matinhure, Karen J Goodman, Sheryl A Mccurdy, Cary A JohnsonAbstract:Background Africa is in an Orphan-care crisis. In Zimbabwe, where one-fourth of adults are HIV-positive and one-fifth of children are Orphans, AIDS and economic decline are straining society's ability to care for Orphans within their extended families. Lack of stable care is putting thousands of children at heightened risk of malnourishment, emotional underdevelopment, illiteracy, poverty, sexual exploitation, and HIV infection, endangering the future health of the society they are expected to sustain.
