Building on past content analyses of presidential debates to determine how format affects the levels of clash and candidates' strategies, this study answers three questions about the 2000 presidential debates: (a) Do candidates differ in their use of clash and nonclash argument strategies? (b) Does format affect candidates' strategic choices? and (c) Does the structure of questions explain strategic choices? Results of the content analysis suggest that format and question content affect candidates' strategic choices; however, other factors including the larger campaign strategy, polling data, and performance in previous debates also influence strategies.

Background: The Health Resources and Services Administration's Ryan White HIV/AIDS Program provides services to more than half of all people diagnosed with HIV in the United States. We present and validate a mathematical model that can be used to estimate the long-term public health and cost impact of the federal program. Methods: We developed a stochastic, agent-based model that reflects the current HIV epidemic in the United States. The model simulates everyone's progression along the HIV care continuum, using 2 network-based mechanisms for HIV transmission: injection drug use and sexual contact. To test the validity of the model, we calculated HIV incidence, mortality, life expectancy, and lifetime care costs and compared the results with external benchmarks. Results: The estimated HIV incidence rate for men who have sex with men (502 per 100,000 person years), mortality rate of all people diagnosed with HIV (1663 per 100,000 person years), average life expectancy for individuals with low CD4 counts not on antiretroviral therapy (1.52–3.78 years), and lifetime costs ($362,385) all met our validity criterion of within 15% of external benchmarks. Conclusions: The model represents a complex HIV care delivery system rather than a single intervention, which required developing solutions to several challenges, such as calculating need for and receipt of multiple services and estimating their impact on care retention and viral suppression. Our strategies to address these methodological challenges produced a valid model for assessing the cost-effectiveness of the Ryan White HIV/AIDS Program.

Background: With an annual budget of more than $2 billion, the Health Resources and Services Administration's Ryan White HIV/AIDS Program (RWHAP) is the third largest source of public funding for HIV care and treatment in the United States, yet little analysis has been done to quantify the long-term public health and economic impacts of the federal program. Methods: Using an agent-based, stochastic model, we estimated health care costs and outcomes over a 50-year period in the presence of the RWHAP relative to those expected to prevail if the comprehensive and integrated system of medical and support services funded by the RWHAP were not available. We made a conservative assumption that, in the absence of the RWHAP, only uninsured clients would lose access to these medical and support services. Results: The model predicts that the proportion of people with HIV who are virally suppressed would be 25.2 percentage points higher in the presence of the RWHAP (82.6 percent versus 57.4 percent without the RWHAP). The number of new HIV infections would be 18 percent (190,197) lower, the number of deaths among people with HIV would be 31 percent (267,886) lower, the number of quality-adjusted life years would be 2.7 percent (5.6 million) higher, and the cumulative health care costs would be 25 percent ($165 billion) higher in the presence of the RWHAP relative to the counterfactual. Based on these results, the RWHAP has an incremental cost-effectiveness ratio of $29,573 per quality-adjusted life year gained compared with the non-RWHAP scenario. Sensitivity analysis indicates that the probability of transmitting HIV via male-to-male sexual contact and the cost of antiretroviral medications have the largest effect on the cost-effectiveness of the program. Conclusions: The RWHAP would be considered very cost-effective when using standard guidelines of less than the per capita gross domestic product of the United States. The results suggest that the RWHAP plays a critical and cost-effective role in the United States' public health response to the HIV epidemic.

Application of the pragma-dialectic perspective, and particularly, strategic maneuvering, to political argumentation remains sparse. To address the issue in the context of the 2008 campaigns, the clash strategies of Barack Obama and John McCain during the debates were coded using the same content analysis codebook as prior analyses of presidential debates, allowing comparison between 2008 and the other nine electoral cycles with general election debates. The 2008 debates included significant shifts in the candidates’ use of ritualistic discourse, direct statements to opponent, self-analysis, opponent analysis, policy statements, comparison, and cooption. Although structural elements continue to serve as a corrective to functional theory, it appeared that the political climate, more than format, explained these changes. The findings suggest that candidates engage in strategic maneuvering consistent with the focal-points perspective and that campaigns engage in competitive learning in an attempt to master format modifications.

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