Detectable HIV Viral Load in Kenya: Data from a Population-Based Survey.

IntroductionAt the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV) transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicator Survey (KAIS 2012) provided a unique opportunity to evaluate the impact of antiretroviral therapy (ART) coverage on viremia and to examine the risks for failure to suppress viral replication. We report population-level HIV viral load suppression using data from KAIS 2012.MethodsBetween October 2012 to February 2013, KAIS 2012 surveyed household members, administered questionnaires and drew serum samples to test for HIV and, for those found to be infected with HIV, plasma viral load (PVL) was measured. Our principal outcome was unsuppressed HIV viremia, defined as a PVL ≥ 550 copies/mL. The exposure variables included current treatment with ART, prior history of an HIV diagnosis, and engagement in HIV care. All point estimates were adjusted to account for the KAIS 2012 cluster sampling design and survey non-response.ResultsOverall, 61·2% (95% CI: 56·4-66·1) of HIV-infected Kenyans aged 15-64 years had not achieved virological suppression. The base10 median (interquartile range [IQR]) and mean (95% CI) VL was 4,633 copies/mL (0-51,596) and 81,750 copies/mL (59,366-104,134), respectively. Among 266 persons taking ART, 26.1% (95% CI: 20.0-32.1) had detectable viremia. Non-ART use, younger age, and lack of awareness of HIV status were independently associated with significantly higher odds of detectable viral load. In multivariate analysis for the sub-sample of patients on ART, detectable viremia was independently associated with younger age and sub-optimal adherence to ART.DiscussionThis report adds to the limited data of nationally-representative surveys to report population- level virological suppression. We established heterogeneity across the ten administrative and HIV programmatic regions on levels of detectable viral load. Timely initiation of ART and retention in care are crucial for the elimination of transmission of HIV through sex, needle and syringe use or from mother to child. Further refinement of geospatial mapping of populations with highest risk of transmission is necessary

Treatment of Scarlatina.

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The Pandemic and its Impacts

The Pandemic has a long history, but the term of “pandemic” is still not been defined by many medical texts. There have been many significant pandemics recorded in human history, and the pandemic related crises have caused enormous negative impacts on health, economies, and even national security in the world. This article will explore the literature for the concept and history of pandemics; summarises the key features of a pandemics, and discusses the negative impacts on health, economy, social and global security of pandemics and disease outbreaks

Amylose in Neurospora.

Amylose in Neurospora

Selected College Students\u27 Knowledge and Perceptions of Biotechnology Issues Reported in the Mass Media

The purpose of this study was to determine college students\u27 awareness of and attitudes toward biotechnology issues reported in the mass media. Future agricultural communicators (N = 330) representing 11 land-grant universities in 10 states recorded their knowledge and perceptions of biotechnology issues as reported in the mass media. Respondents were mostly seniors (46%), female (55%), and considered themselves 8 average students (60%). Students achieved only 30% correct responses (M = 3.05) in a knowledge assessment of biotechnology practices, illustrating a lack of knowledge. However, nearly 84% of the respondents perceived their level of knowledge as average to high (24% perceived they possessed above-average scientific knowledge). Future agricultural communicators were somewhat accepting of biotechnology practices for genetically modified organisms involving plant life (M = 3.28), but viewed these same practices as somewhat unacceptable for use on humans (M = 1.84). Significant, low positive relationships existed between respondents\u27 perceived and assessed levels ofbiotechnology knowledge (r = .17) and between their assessed knowledge and acceptance of biotechnology practices (r = .16). Selected college students in the agricultural sciences have much less knowledge about biotechnology practices than what they believed to possess. Although correctable through increased study of biotechnology, this finding may pose serious problems for students choosing to communicate the science of biotechnology issues in the mass media. Agricultural communications faculty nationwide should analyze their curricula to determine if students are being given the opportunity to study biotechnology issues while learning how to communicate it to a larger audience

UAV Model-based Flight Control with Artificial Neural Networks: A Survey

Model-Based Control (MBC) techniques have dominated flight controller designs for Unmanned Aerial Vehicles (UAVs). Despite their success, MBC-based designs rely heavily on the accuracy of the mathematical model of the real plant and they suffer from the explosion of complexity problem. These two challenges may be mitigated by Artificial Neural Networks (ANNs) that have been widely studied due to their unique features and advantages in system identification and controller design. Viewed from this perspective, this survey provides a comprehensive literature review on combined MBC-ANN techniques that are suitable for UAV flight control, i.e., low-level control. The objective is to pave the way and establish a foundation for efficient controller designs with performance guarantees. A reference template is used throughout the survey as a common basis for comparative studies to fairly determine capabilities and limitations of existing research. The end-result offers supported information for advantages, disadvantages and applicability of a family of relevant controllers to UAV prototypes

Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis.

BackgroundEconomic compensation interventions may help support higher voluntary medical male circumcision (VMMC) coverage in priority sub-Saharan African countries. To inform World Health Organization guidelines, we conducted a systematic review of economic compensation interventions to increase VMMC uptake.MethodsEconomic compensation interventions were defined as providing money or in-kind compensation, reimbursement for associated costs (e.g. travel, lost wages), or lottery entry. We searched five electronic databases and four scientific conferences for studies examining the impact of such interventions on VMMC uptake, HIV testing and safer-sex/risk-reduction counseling uptake within VMMC, community expectations about compensation, and potential coercion. We screened citations, extracted data, and assessed risk of bias in duplicate. We conducted random-effects meta-analysis. We also reviewed studies examining acceptability, values/preferences, costs, and feasibility.ResultsOf 2484 citations identified, five randomized controlled trials (RCTs) and three non-randomized controlled trials met our eligibility criteria. Studies took place in Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Meta-analysis of four RCTs showed significant impact of any economic compensation on VMMC uptake (relative risk: 5.23, 95% CI: 3.13 to 8.76). RCTs of food/transport vouchers and conditional cash transfers generally showed increases in VMMC uptake, but lotteries, subsidized VMMC, and receiving a gift appeared somewhat less effective. Three non-randomized trials showed mixed impact. Six additional studies suggested economic compensation interventions were generally acceptable, valued for addressing key barriers, and motivating to men. However, some participants felt they were insufficiently motivating or necessary; one study suggested they might raise community suspicions. One study from South Africa found a program cost of US$91 per additional circumcision and US$450-$1350 per HIV infection averted.ConclusionsEconomic compensation interventions, particularly transport/food vouchers, positively impacted VMMC uptake among adult men and were generally acceptable to potential clients. Carefully selected economic interventions may be a useful targeted strategy to enhance VMMC coverage

Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review.

BackgroundVoluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify.MethodsWe systematically reviewed the literature to evaluate the impact of service delivery interventions (e.g., facility layout, service co-location, mobile outreach) on VMMC uptake among adolescent and adult men. For the main effectiveness review, we searched for publications or conference abstracts that measured VMMC uptake or uptake of HIV testing or risk reduction counselling within VMMC services. We synthesized data by coding categories and outcomes. We also reviewed studies assessing acceptability, values/preferences, costs, and feasibility.ResultsFour randomized controlled trials and five observational studies were included in the effectiveness review. Studies took place in South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. They assessed a range of service delivery innovations, including community-, school-, and facility-based interventions. Overall, interventions increased VMMC uptake; some successfully improved uptake among age-specific subpopulations, but urban-rural stratification showed no clear trends. Interventions that increased adult men's uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies.ConclusionsInnovative changes in male-centered VMMC services can improve adult men's and adolescent boys' VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation