Home-based versus clinic-based care for patients starting antiretroviral therapy with low CD4⁺ cell counts: findings from a cluster-randomized trial.

OBJECTIVES: African health services have shortages of clinical staff. We showed previously, in a cluster-randomized trial, that a home-based strategy using trained lay-workers is as effective as a clinic-based strategy. It is not known whether home-based care is suitable for patients with advanced HIV disease. METHODS: The trial was conducted in Jinja, Uganda. One thousand, four hundred and fifty-three adults initiating ART between February 2005 and January 2009 were randomized to receive either home-based care or routine clinic-based care, and followed up for about 3 years. Trained lay workers, supervised by clinical staff based in a clinic, delivered the home-based care. In this sub-analysis, we compared survival between the two strategies for those who presented with CD4⁺ cell count less than 50 cells/μl and those who presented with higher CD4⁺ cell counts. We used Kaplan-Meier methods and Poisson regression. RESULTS: Four hundred and forty four of 1453 (31%) participants had baseline CD4⁺ cell count less than 50 cells/μl. Overall, 110 (25%) deaths occurred among participants with baseline CD4⁺ cell count less than 50  cells/μl and 87 (9%) in those with higher CD4⁺ cell count. Among participants with CD4 cell count less than 50  cells/μl, mortality rates were similar for the home and facility-based arms; adjusted mortality rate ratio 0.80 [95% confidence interval (CI) 0.53-1.18] compared with 1.22 (95% CI 0.78-1.89) for those who presented with higher CD4⁺ cell count. CONCLUSION: HIV home-based care, with lay workers playing a major role in the delivery of care including providing monthly adherence support, leads to similar survival rates as clinic-based care even among patients who present with very low CD4⁺ cell count. This emphasises the critical role of adherence to antiretroviral therapy

Similar mortality and reduced loss to follow-up in integrated compared with vertical programs providing antiretroviral treatment in sub-saharan Africa.

Vertical HIV programs have achieved good results but may not be feasible or appropriate in many resource-limited settings. Médecins sans Frontières has treated HIV in vertical programs since 2000 and over time integrated HIV treatment into general health care services using simplified protocols. We analyzed the survival probability among patients receiving antiretroviral therapy (ART) from 2003 to 2010 in integrated versus vertical programs in 9 countries in sub-Saharan Africa

How does twine thickness and mesh size affect catch efficiency and ways of capture in the Northeast Arctic cod (Gadus morhua) gillnet fishery?

The aim of this study is to establish a general pattern for how round-fish get caught in gillnets. Understanding these patterns might further help establishing which gillnet parameters are important to consider when developing new biodegradable materials for gillnets. Developing biodegradable materials is important to reduce impacts from lost, abandoned, and discarded gillnets made of non-biodegradable materials. The study was conducted by comparing catch efficiency and way of capture of Northeast Arctic cod (Gadus morhua) in different gillnet types with two different twine thicknesses (0.7 mm and 0.8 mm) and two different mesh sizes (210 mm and 230 mm). The fishing trials were conducted onboard commercial fishing vessel ‘Karoline’ during the main season for Northeast Arctic cod in Northern Norway, lasting from late January to mid-March 2022. Furthermore, circumference measurements were collected for Northeast Arctic cod to establish a relationship between fish morphology, gillnet mesh size and fish length dependent capture in gillnets during a cruise with research vessel ‘Helmer Hanssen’. During the same cruise, to further support establishing gillnet capture patterns for Northeast Arctic cod, a laboratory experiment was conducted with a gillnet and dead cod by investigating the point of capture when letting fish through a gillnet mesh. The results from the gillnet fishing experiments did not detect any significant differences in catch efficiency between the two twine thicknesses for either mesh size, implying that capture efficiencyhas some tolerance regarding this design parameter and therefore also regarding the associated twine elasticity/stiffness. Analysing the ways of capture showed that this was dependent on the length of the fish. Overall, 76 % of the fish were caught by either gilling or wedging, the latter being the overall most dominant of all ways of capture. The remaining fish were mainly caught by snagging, while entangling constituted a minor proportion. Furthermore, the way of capture probability was not affected by an increase in twine thickness, but a significant change was observed when increasing the mesh size, more specifically snagging and wedging. Fall-through results showed similar patterns regarding length dependent ways of capture as the gillnet fishing trials and can therefore be used to supplement investigations based on the latter. For the dominant ways of capture, gilling and wedging, the cod circumference was approximately 20 % larger than mesh circumference. This knowledge can be applied to select the mesh size for the gillnets, dependent on what size of cod that are targeted at the specific area. The results from this study have increased the understanding of the effect of twine thickness and mesh size for capture patterns. This is important knowledge for the further development of biodegradable material used in gillnets as an alternative to nylon. We now know that we can operate within a range of twine thicknesses for the same mesh size without significantly influencing the capture pattern

Used vs. new: Does it have consequences for the performance of fishing gear?

Sea trials to test size selectivity equipment in trawls are often limited in time because they are costly, and the results can be influenced by multiple factors that are often overlooked. In the Barents Sea gadoid trawl fishery, the use of a size sorting grid in front of the codend is compulsory. The flexigrid, a netting section containing two flexible grids, is the most widely used grid section in this fishery. However, earlier selectivity studies with this device have shown inconclusive results. It has been speculated that the differences observed resulted from the difference in age and usage of the grid sections in the studies compared. To reveal whether potential changes in the device construction over time can lead to differences in size selection properties, we performed comparative fishing trials where we compared a brand new flexigrid section and a well-used flexigrid section used continuously by a commercial trawler for approximately four years. The results showed that the new flexigrid released significantly more cod below ∼60 cm than the used flexigrid. However, when the grids were fished with a subsequent diamond mesh codend, there was no difference in the overall selectivity of the two gears, meaning that the size selectivity in the codend compensates for the potential reduction in selectivity performance of the grids. This study shows the importance of considering the age and earlier use of size selection devices like sorting grids before they are compared with other devices, as their size selection properties can change significantly over time and with use.publishedVersio

Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.

BACKGROUND: Many HIV-infected children in Southern Africa have been started on antiretroviral therapy (ART), but loss to follow up (LTFU) can be substantial. We analyzed mortality in children retained in care and in all children starting ART, taking LTFU into account. PATIENTS AND METHODS: Children who started ART before the age of 16 years in 10 ART programs in South Africa, Malawi, Mozambique, and Zimbabwe were included. Risk factors for death in the first year of ART were identified in Weibull models. A meta-analytic approach was used to estimate cumulative mortality at 1 year. RESULTS: Eight thousand two hundred twenty-five children (median age 49 months, median CD4 cell percent 11.6%) were included; 391 (4.8%) died and 523 (7.0%) were LTFU in the first year. Mortality at 1 year was 4.5% [95% confidence interval (CI): 2.8% to 7.4%] in children remaining in care, but 8.7% (5.4% to 12.1%) at the program level, after taking mortality in children and LTFU into account. Factors associated with mortality in children remaining in care included age [adjusted hazard ratio (HR) 0.37; 95% CI: 0.25 to 0.54 comparing > or =120 months with <18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparing > or =20% with <10%), and clinical stage (HR: 0.12; 95% CI: 0.03 to 0.45 comparing World Health Organization stage I with III/IV). CONCLUSIONS: In children starting ART and remaining in care in Southern Africa mortality at 1 year is <5% but almost twice as high at the program level, when taking LTFU into account. Age, CD4 percentage, and clinical stage are important predictors of mortality at the individual level

Condition-dependent signaling affects male sexual attractiveness in field crickets, Gryllus campestris

The condition dependence of sexually selected traits is an important assumption of sexual selection theory. Several laboratory studies have documented a positive relationship between food availability, body condition, and sexual display. However, these studies might not reflect the resource allocation between body maintenance, reserves, and the sexually selected trait under natural conditions. Further, the effect of condition-dependent signaling on female mate choice has hardly been investigated experimentally in the field. We therefore investigated the effect of food availability on body condition, calling behavior, and sexual attractiveness of male field crickets, Gryllus campestris, under field conditions. Food availability was manipulated for individual males by supplementing food in a confined area close to the burrow. Food-supplemented males showed a significant increase in body condition, whereas the opposite was found in the control males. Males receiving extra food called more frequently, whereas the calling-song characteristics were not affected by the treatment. Further, food-supplemented males attracted more females than did control males, and their higher attractiveness was partly explained by their superior calling rate. Our study thus indicates condition-dependent signaling as an important determinant of the sexual attractiveness of males to females under natural conditio

Математичне моделювання стаціонарного теплопереносу в процесах випікання тонких плоских тістових заготовок

Розглянуто математичну модель стаціонарного теплопереносу в процесах випікання тонких плоских тістових заготовок. Проведено числове моделювання і аналіз стаціонарних температурних полів для нагрівальної плити і заготовки з точки зору забезпечення більшої рівномірності нагріву за різними напрямками із врахуванням частотних характеристик нагрівання.Mathematical model of stationary heat transfer for baking processes of thin flat pastry blanks are considered. Numerical modeling and analyze of stationary temperature fields for hot plane and blank are conducted with taking into account condition of regular heating for different directions and heating frequencies characteristics

Treatment outcomes from the largest antiretroviral treatment program in Myanmar (Burma): a cohort analysis of retention after scale-up.

Article approval pendingAntiretroviral treatment (ART) coverage in Myanmar is well below average. This study describes retention and baseline predictors of prognosis from the largest ART program in the country

Brood size, sibling competition, and the cost of begging in great tits (Parus major)

Evolutionary theory of parent-offspring conflict explains begging displays of nestling birds as selfish attempts to influence parental food allocation. Models predict that this conflict may be resolved by honest signaling of offspring need to parents, or by competition among nestmates, leading to escalated begging scrambles. Although the former type of models has been qualitatively supported by experimental studies, the potential for a begging component driven by scramble competition cannot be excluded by the evidence. In a brood-size manipulation experiment with great tits, Parus major, we explored the scramble component in the begging activity of great tit nestlings by investigating the mechanisms of sibling competition in relation to brood size. While under full parental compensation, the feeding rate per nestling will remain constant over all brood sizes for both types of models; the scramble begging models alone predict an increase in begging intensity with brood size, if begging costs do not arise exclusively through predation. Great tit parents adjusted feeding rates to brood size and fed nestlings at similar rates and with similar prey sizes in all three brood-size categories. Despite full parental compensation, the begging and food solicitation activities increased with experimental brood size, whereas nestling body condition deteriorated. These findings support a scramble component in begging and suggest that the competition-induced costs of food solicitation behavior play an important role in the evolution of parent-offspring communicatio