HIV Testing and Diagnosis Rates in Kiev, Ukraine: April 2013-March 2014

Data from Ukraine on risk factors for HIV acquisition are limited. We describe the characteristics of individuals testing for HIV in the main testing centres of the Ukrainian capital Kiev, including HIV risk factors, testing rates, and positivity rates. As part of a larger study to estimate HIV incidence within Kiev City, we included questions on possible risk factors for HIV acquisition and testing history to existing systems in 4 infectious disease clinics. Data were provided by the person requesting an HIV test using a handheld electronic tablet. All persons (≥16 yrs) presenting for an HIV test April 2013-March 2014 were included. Rates per 100,000 were calculated using region-specific denominators for Kiev. During the study period 6370 individuals tested for HIV, equivalent to a testing rate of 293.2 per 100,000. Of these, 467 (7.8%) were HIV-positive, with the highest proportion positive among 31-35 year olds (11.2%), males (9.4%), people who inject drugs (PWID) (17.9%) and men who have sex with men (MSM) (24.1%). Using published population size estimates of MSM, diagnosis rates for MSM ranged from 490.6 to 1548.3/100,000. A higher proportion of heterosexual women compared to heterosexual men reported contact with PWID, (16% vs. 4.7%) suggesting a bridging in risk between PWID and their sexual partners. Collection of HIV risk factor information in Kiev, essential for the purposes of developing effective HIV prevention and response tools, is feasible. The high percentage of MSM among those testing positive for HIV, may indicate a significant level of undisclosed sex between men in national figures

現地観測に基づく河川流の乱流特性に関する研究

博士（工学）神戸大

A Phylogenetic Analysis of Human Immunodeficiency Virus Type 1 Sequences in Kiev: Findings Among Key Populations

Background: The human immunodeficiency virus (HIV) epidemic in Ukraine has been driven by a rapid rise among people who inject drugs, but recent studies have shown an increase through sexual transmission. Methods: Protease and reverse transcriptase sequences from 876 new HIV diagnoses (April 2013–March 2015) in Kiev were linked to demographic data. We constructed phylogenetic trees for 794 subtype A1 and 64 subtype B sequences and identified factors associated with transmission clustering. Clusters were defined as ≥2 sequences, ≥80% local branch support, and maximum genetic distance of all sequence pairs in the cluster ≤2.5%. Recent infection was determined through the limiting antigen avidity enzyme immunoassay. Sequences were analyzed for transmitted drug resistance mutations. Results Thirty percent of subtype A1 and 66% of subtype B sequences clustered. Large clusters (maximum 11 sequences) contained mixed risk groups. In univariate analysis, clustering was significantly associated with subtype B compared to A1 (odds ratio [OR], 4.38 [95% confidence interval {CI}, 2.56–7.50]); risk group (OR, 5.65 [95% CI, 3.27–9.75]) for men who have sex with men compared to heterosexual males; recent, compared to long-standing, infection (OR, 2.72 [95% CI, 1.64–4.52]); reported sex work contact (OR, 1.93 [95% CI, 1.07–3.47]); and younger age groups compared with age ≥36 years (OR, 1.83 [95% CI, 1.10–3.05] for age ≤25 years). Females were associated with lower odds of clustering than heterosexual males (OR, 0.49 [95% CI, .31–.77]). In multivariate analysis, risk group, subtype, and age group were independently associated with clustering (P < .001, P = .007, and P = .033, respectively). Eighteen sequences (2.1%) indicated evidence of transmitted drug resistance. Conclusions Our findings suggest high levels of transmission and bridging between risk groups

SN 2017dio: A Type-Ic Supernova Exploding in a Hydrogen-rich Circumstellar Medium

SN 2017dio shows both spectral characteristics of a type-Ic supernova (SN) and signs of a hydrogen-rich circumstellar medium (CSM). Prominent, narrow emission lines of H and He are superposed on the continuum. Subsequent evolution revealed that the SN ejecta are interacting with the CSM. The initial SN Ic identification was confirmed by removing the CSM interaction component from the spectrum and comparing with known SNe Ic, and reversely, adding a CSM interaction component to the spectra of known SNe Ic and comparing them to SN 2017dio. Excellent agreement was obtained with both procedures, reinforcing the SN Ic classification. The light curve constrains the pre-interaction SN Ic peak absolute magnitude to be around Mg = −17.6 mag. No evidence of significant extinction is found, ruling out a brighter luminosity required by a SN Ia classification. These pieces of evidence support the view that SN 2017dio is a SN Ic, and therefore the first firm case of a SN Ic with signatures of hydrogen-rich CSM in the early spectrum. The CSM is unlikely to have been shaped by steady-state stellar winds. The mass loss of the progenitor star must have been intense, ˙M 0.02 (ǫH/0.01)−1 (vwind/500 km s−1) (vshock/10000 km s−1)−3 M⊙ yr−1, peaking at a few decades before the SN. Such a high mass loss rate might have been experienced by the progenitor through eruptions or binary stripping. Keywords: supernovae: general — supernovae: individual (SN 2017dio)</p

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

HTLV-I clinical pathological spectrum HTLV-I espectro clínico patológico

HTLV-I has been revealed as the etiological factor of the Tropical Spastic Paraparesis (TSP) and of the T-cell leukemia-lymphoma of the adult (ATLL). Recently, it has also been associated to some forms of polymyositis, polyarthritis, polyneuropathies, Sjögren's syndrome, thrombocytopenia and lympho-alveolitis. The clinical and pathological spectrum of this retrovirus is analyzed taking into account the Chilean cases and those reported by the international medical literature

Data-Driven Risk Matrices for CERN’s Accelerators

A risk matrix is a common tool used in risk assessment, defining risk levels with respect to the severity and probability of the occurrence of an undesired event. Risk levels can then be used for different purposes, e.g. defining subsystem reliability or personnel safety requirements. Over the history of the Large Hadron Collider (LHC), several risk matrices have been defined to guide system design. Initially, these were focused on machine protection systems, more recently these have also been used to prioritize consolidation activities. A new data-driven development of risk matrices for CERN’s accelerators is presented in this paper, based on data collected in the CERN Accelerator Fault Tracker (AFT). The data-driven approach improves the granularity of the assessment, and limits uncertainty in the risk estimation, as it is based on operational experience. In this paper the authors introduce the mathematical framework, based on operational failure data, and present the resulting risk matrix for LHC

Machine learning for early fault detection in accelerator systems

With the development of systems based on a combination of mechanics, electronics and – more and more - software components, increasing system complexity is a de facto trend in the engineering world. Particle accelerators make no exception to this paradigm. The continuous push for higher energies driven by particle physics implies that next generation machines will be at least one order of magnitude larger and more complex than present ones, posing unprecedented challenges in terms of beam performance and availability. The two most promising approaches CERN discusses as next generation projects are the Future Circular Collider (FCC) and the Compact Linear Collider (CLIC), with a size of 100 km and 48 km, respectively (see Fig.1 and Fig. 2)

Availability Modeling of the Solid-State Power Amplifiers for the CERN SPS RF Upgrade

As part of the LHC Injector Upgrade program a complete overhaul of the Super Proton Synchrotron Radio-Frequency (RF) system took place. New cavities have been installed for which the solid-state technology was chosen to deliver a combined RF power of 2 MW from 2560 RF amplifiers. This strategy promises high availability as the system continues operation when some of the amplifiers fail. This study quantifies the operational availability that can be achieved with this new installation. The evaluation is based on a Monte Carlo simulation of the system using the novel AvailSim4 simulation software. A model based on lifetime estimations of the RF modules is compared against data from early operational experience. Sensitivity analyses have been made, that give insight to the chosen operational scenario. With the increasing use of solid-state RF power amplifiers, the findings of this study provide a useful reference for future application of this technology in particle accelerators

Reliability Analysis of the HL-LHC Energy Extraction System

The energy extraction systems for the protection of the new HL-LHC superconducting magnet circuits are based on vacuum breakers. This technology allows to significantly reduce the switch opening time and increases the overall system reliability with reduced maintenance needs. This paper presents the results of detailed reliability studies performed on these new energy extraction systems. The study quantifies the risk of a failure which prevents correct protection of a magnet circuit and identifies the most critical components of the system. For this, the model considers factors such as block or component level failure probabilities, different maintenance strategies and repair procedures. The reliability simulations have been performed with AvailSim4, a novel Monte Carlo code for availability and reliability simulations. The results are compared with the system reliability requirements and provides insights into the most critical components