Improved HIV testing coverage after scale-up of antiretroviral therapy programs in urban Zambia: Evidence from serial hospital surveillance

Background: We evaluated changing HIV testing coverage and prevalence rates before and after expanding city-wide antiretroviral therapy (ART) programs in Lusaka, Zambia.Methods: We conducted serial cross-sectional surveys on the University Teaching Hospital medical ward to assess HIV prevalence among inpatients of unknown status in 2003 and 2006. Willing participants received counseling and dual HIV rapid tests. We compared the proportion of inpatients receiving their test results in 2003 (off-the-ward testing) to 2006 (on-the-ward).Results: In 2003, none of 103 inpatients knew their HIV status or took ART; 99.0% (102/103) agreed to testing. In 2006, 49.3% (99 of 201) patients knew they were HIV-infected and were on ART; of those with unknown status, 98.0% (100/102) agreed to testing. In 2003, only 54.9% (56/102) received posttest counseling and 98.2% (55/56) learned their status. In 2006, 99.0% (99/100) received post-test counseling and 99.1% (98 of 99) learned their status. In 2003, 62.8% (64 of 102) of status- unknown inpatients who agreed to testing were seropositive by dual rapid test, compared to 48.0% (48 of 100) of status-unknown inpatients in 2006. When including inpatients who already knew their seropositive status plus those unknowns who tested seropositive, the proportion of inpatients that was seropositive in 2006 was 73.1% (147 of 201), higher than in 2003.Conclusions: After ART program expansion, inpatients in 2006 were far more likely than their 2003 counterparts to know their HIV status and to be taking ART. In both years, 63-73% of medical inpatients were HIV-infected and 98.5% of inpatients agreed to testing. On-the-ward testing in 2006 avoided the 2003 problem of patient discharge before learning of their test results. Hospital-based HIV testing is an essential clinical service in high prevalence settings and can serve further as a surveillance system to help track the community impact of outpatient AIDS services in Africa.Keywords: HIV, testing, surveillance, Zambi

Telemetry tails: a practical method for attaching animal-borne devices to small vertebrates in the field

Context. Continued miniaturisation of tracking technology increases its utility in animal applications. However, species morphology often dictates the type of animal-borne device (ABD) that can be used, and how it is attached. The morphology of species within Peramelemorphia preclude them from the standard collar attachment of ABDs for terrestrial mammals. Aims. This paper describes a method for the tail-mount attachment of ABDs, and deployment results for Peramelemorphia across arid, semi-arid and temperate Australia to (a) test the performance of attachments and ABDs in the field and (b) discuss the animal welfare considerations for this attachment method. Methods. Tail-mount attachment of ABDs were field-tested on a total of 80 greater bilbies (Macrotis lagotis), and 14 long-nosed bandicoots (Perameles nasuta). Key results. Time to natural detachment (TTND) was between 2 and 52 days, with 65.74% (142 of 216) remaining on until manual removal. For ABDs that were manually removed, attachments were retained for up to 94 days. The method used for tail-mount attachment of ABDs to long-nosed bandicoots resulted in significantly shorter TTND compared with the method used for bilbies, and environmental factors (high temperatures and rainfall) had a negative effect on TTND. Tail-mount attached global positioning system (GPS) sensors collected large quantities of accurate data, with a maximum fix success rate of 83.38%. Damage to GPS (antenna breakage and water ingress) during deployment, however, impacted performance. In environments with frequent rainfall and waterlogged soils, the tape on a small proportion (6.25%) of (n = 192)attachments to bilbies caused tail injury. All injuries were resolvable, with most requiringminimal to no veterinary intervention. Key conclusions. Attachment longevity can be affectedby how the ABD is mounted to the tail, the species and the deployment environment. Theenvironment can also affect which adhesive tapes are suitable for ABD attachment. However, thismethod is highly modifiable, practical for field application and can have long retention timesrelative to other temporary methods. Implications. This ABD tail-mount attachment methodadds another tool to the telemetry tool-kit, with all the benefits of a low-tech, low-cost, passivedrop-off type attachment. This method has demonstrated practicality for Peramelemorphia, withpotential application to other suitable small vertebrates

Effective Edge-Fault-Tolerant Single-Source Spanners via Best (or Good) Swap Edges

Computing \emph{all best swap edges} (ABSE) of a spanning tree $T$ of a given $n$-vertex and $m$-edge undirected and weighted graph $G$ means to select, for each edge $e$ of $T$, a corresponding non-tree edge $f$, in such a way that the tree obtained by replacing $e$ with $f$ enjoys some optimality criterion (which is naturally defined according to some objective function originally addressed by $T$). Solving efficiently an ABSE problem is by now a classic algorithmic issue, since it conveys a very successful way of coping with a (transient) \emph{edge failure} in tree-based communication networks: just replace the failing edge with its respective swap edge, so as that the connectivity is promptly reestablished by minimizing the rerouting and set-up costs. In this paper, we solve the ABSE problem for the case in which $T$ is a \emph{single-source shortest-path tree} of $G$, and our two selected swap criteria aim to minimize either the \emph{maximum} or the \emph{average stretch} in the swap tree of all the paths emanating from the source. Having these criteria in mind, the obtained structures can then be reviewed as \emph{edge-fault-tolerant single-source spanners}. For them, we propose two efficient algorithms running in $O(m n +n^2 \log n)$ and $O(m n \log \alpha(m,n))$ time, respectively, and we show that the guaranteed (either maximum or average, respectively) stretch factor is equal to 3, and this is tight. Moreover, for the maximum stretch, we also propose an almost linear $O(m \log \alpha(m,n))$ time algorithm computing a set of \emph{good} swap edges, each of which will guarantee a relative approximation factor on the maximum stretch of $3/2$ (tight) as opposed to that provided by the corresponding BSE. Surprisingly, no previous results were known for these two very natural swap problems.Comment: 15 pages, 4 figures, SIROCCO 201

Population Selection and Sequencing of Caenorhabditis elegans Wild Isolates Identifies a Region on Chromosome III Affecting Starvation Resistance

To understand the genetic basis of complex traits, it is important to be able to efficiently phenotype many genetically distinct individuals. In the nematode Caenorhabditis elegans, individuals have been isolated from diverse populations around the globe and whole-genome sequenced. As a result, hundreds of wild strains with known genome sequences can be used for genome-wide association studies (GWAS). However, phenotypic analysis of these strains can be laborious, particularly for quantitative traits requiring multiple measurements per strain. Starvation resistance is likely a fitness-proximal trait for nematodes, and it is related to metabolic disease risk in humans. However, natural variation in C. elegans starvation resistance has not been systematically characterized, and precise measurement of the trait is time-intensive. Here, we developed a population-selection-and-sequencing-based approach to phenotype starvation resistance in a pool of 96 wild strains. We used restriction site-associated DNA sequencing (RAD-seq) to infer the frequency of each strain among survivors in a mixed culture over time during starvation. We used manual starvation survival assays to validate the trait data, confirming that strains that increased in frequency over time are starvation-resistant relative to strains that decreased in frequency. Further, we found that variation in starvation resistance is significantly associated with variation at a region on chromosome III. Using a near-isogenic line (NIL), we showed the importance of this genomic interval for starvation resistance. This study demonstrates the feasibility of using population selection and sequencing in an animal model for phenotypic analysis of quantitative traits, documents natural variation of starvation resistance in C. elegans, and identifies a genomic region that contributes to such variation

Climate change adaptation, flood risks and policy coherence in integrated water resources management in England

Integrated water resources management (IWRM) assumes coherence between cognate aspects of water governance at the river basin scale, for example water quality, energy production and agriculture objectives. But critics argue that IWRM is often less ‘integrated’ in practice, raising concerns over inter-sectoral coherence between implementing institutions. One increasingly significant aspect of IWRM is adaptation to climate change-related risks, including threats from flooding, which are particularly salient in England. Although multiple institutional mechanisms exist for flood risk management (FRM), their coherence remains a critical question for national adaptation. This paper therefore (1) maps the multi-level institutional frameworks determining both IWRM and FRM in England; (2) examines their interaction via various inter-institutional coordinating mechanisms; and (3) assesses the degree of coherence. The analysis suggests that cognate EU strategic objectives for flood risk assessment demonstrate relatively high vertical and horizontal coherence with river basin planning. However, there is less coherence with flood risk requirements for land-use planning and national flood protection objectives. Overall, this complex governance arrangement actually demonstrates de-coherence over time due to ongoing institutional fragmentation. Recommendations for increasing IWRM coherence in England or re-coherence based on greater spatial planning and coordination of water-use and land-use strategies are proposed

Does shear wave ultrasound independently predict axillary lymph node metastasis in women with invasive breast cancer?

Shear wave elastography (SWE) shows promise as an adjunct to greyscale ultrasound examination in assessing breast masses. In breast cancer, higher lesion stiffness on SWE has been shown to be associated with features of poor prognosis. The purpose of this study was to assess whether lesion stiffness at SWE is an independent predictor of lymph node involvement. Patients with invasive breast cancer treated by primary surgery, who had undergone SWE examination were eligible. Data were retrospectively analysed from 396 consecutive patients. The mean stiffness values were obtained using the Aixplorer(®) ultrasound machine from SuperSonic Imagine Ltd. Measurements were taken from a region of interest positioned over the stiffest part of the abnormality. The average of the mean stiffness value obtained from each of two orthogonal image planes was used for analysis. Associations between lymph node involvement and mean lesion stiffness, invasive cancer size, histologic grade, tumour type, ER expression, HER-2 status and vascular invasion were assessed using univariate and multivariate logistic regression. At univariate analysis, invasive size, histologic grade, HER-2 status, vascular invasion, tumour type and mean stiffness were significantly associated with nodal involvement. Nodal involvement rates ranged from 7 % for tumours with mean stiffness <50 kPa to 41 % for tumours with a mean stiffness of >150 kPa. At multivariate analysis, invasive size, tumour type, vascular invasion, and mean stiffness maintained independent significance. Mean stiffness at SWE is an independent predictor of lymph node metastasis and thus can confer prognostic information additional to that provided by conventional preoperative tumour assessment and staging

Combining shallow-water and analytical wake models for tidal-array micro-siting

For tidal-stream energy to become a competitive renewable energy source, clustering multiple turbines into arrays is paramount. Array optimisation is thus critical for achieving maximum power performance and reducing cost of energy. However, ascertaining an optimal array layout is a complex problem, subject to specific site hydrodynamics and multiple inter-disciplinary constraints. In this work, we present a novel optimisation approach that combines an analytical-based wake model, FLORIS, with an ocean model, Thetis. The approach is demonstrated through applications of increasing complexity. By utilising the method of analytical wake superposition, the addition or alteration of turbine position does not require re-calculation of the entire flow field, thus allowing the use of simple heuristic techniques to perform optimisation at a fraction of the computational cost of more sophisticated methods. Using a custom condition-based placement algorithm, this methodology is applied to the Pentland Firth for arrays with turbines of 3.05m/s rated speed, demonstrating practical implications whilst considering the temporal variability of the tide. For a 24-turbine array case, micro-siting using this technique delivered an array 15.8% more productive on average than a staggered layout, despite flow speeds regularly exceeding the rated value. Performance was evaluated through assessment of the optimised layout within the ocean model that treats turbines through a discrete turbine representation. Used iteratively, this methodology could deliver improved array configurations in a manner that accounts for local hydrodynamic effects

The developmental dynamics of terrorist organizations

We identify robust statistical patterns in the frequency and severity of violent attacks by terrorist organizations as they grow and age. Using group-level static and dynamic analyses of terrorist events worldwide from 1968-2008 and a simulation model of organizational dynamics, we show that the production of violent events tends to accelerate with increasing size and experience. This coupling of frequency, experience and size arises from a fundamental positive feedback loop in which attacks lead to growth which leads to increased production of new attacks. In contrast, event severity is independent of both size and experience. Thus larger, more experienced organizations are more deadly because they attack more frequently, not because their attacks are more deadly, and large events are equally likely to come from large and small organizations. These results hold across political ideologies and time, suggesting that the frequency and severity of terrorism may be constrained by fundamental processes.Comment: 28 pages, 8 figures, 4 tables, supplementary materia

Evaluating Effects of Divided Hemispheric Processing on Word Recognition in Foveal and Extrafoveal Displays: The Evidence from Arabic

Background: Previous studies have claimed that a precise split at the vertical midline of each fovea causes all words to the left and right of fixation to project to the opposite, contralateral hemisphere, and this division in hemispheric processing has considerable consequences for foveal word recognition. However, research in this area is dominated by the use of stimuli from Latinate languages, which may induce specific effects on performance. Consequently, we report two experiments using stimuli from a fundamentally different, non-Latinate language (Arabic) that offers an alternative way of revealing effects of split-foveal processing, if they exist. Methods and Findings: Words (and pseudowords) were presented to the left or right of fixation, either close to fixation and entirely within foveal vision, or further from fixation and entirely within extrafoveal vision. Fixation location and stimulus presentations were carefully controlled using an eye-tracker linked to a fixation-contingent display. To assess word recognition, Experiment 1 used the Reicher-Wheeler task and Experiment 2 used the lexical decision task. Results: Performance in both experiments indicated a functional division in hemispheric processing for words in extrafoveal locations (in recognition accuracy in Experiment 1 and in reaction times and error rates in Experiment 2) but no such division for words in foveal locations. Conclusions: These findings from a non-Latinate language provide new evidence that although a functional division i

An ERP Assessment of Hemispheric Projections in Foveal and Extrafoveal Word Recognition

The existence and function of unilateral hemispheric projections within foveal vision may substantially affect foveal word recognition. The purpose of this research was to reveal these projections and determine their functionality.Single words (and pseudowords) were presented to the left or right of fixation, entirely within either foveal or extrafoveal vision. To maximize the likelihood of unilateral projections for foveal displays, stimuli in foveal vision were presented away from the midline. The processing of stimuli in each location was assessed by combining behavioural measures (reaction times, accuracy) with on-line monitoring of hemispheric activity using event-related potentials recorded over each hemisphere, and carefully-controlled presentation procedures using an eye-tracker linked to a fixation-contingent display.Event-related potentials 100–150 ms and 150–200 ms after stimulus onset indicated that stimuli in extrafoveal and foveal locations were projected unilaterally to the hemisphere contralateral to the presentation hemifield with no concurrent projection to the ipsilateral hemisphere. These effects were similar for words and pseudowords, suggesting this early division occurred before word recognition. Indeed, event-related potentials revealed differences between words and pseudowords 300–350 ms after stimulus onset, for foveal and extrafoveal locations, indicating that word recognition had now occurred. However, these later event-related potentials also revealed that the hemispheric division observed previously was no longer present for foveal locations but remained for extrafoveal locations. These findings closely matched the behavioural finding that foveal locations produced similar performance each side of fixation but extrafoveal locations produced left-right asymmetries.These findings indicate that an initial division in unilateral hemispheric projections occurs in foveal vision away from the midline but is not apparent, or functional, when foveal word recognition actually occurs. In contrast, the division in unilateral hemispheric projections that occurs in extrafoveal locations is still apparent, and is functional, when extrafoveal word recognition takes place