Evaluation of the effectiveness of the national Prevention of Mother-to-Child Transmission (PMTCT) programme on infant HIV measured at six weeks postpartum in South Africa

Aims and Objectives: The overall aim of this evaluation was to conduct a national facility-based survey to monitor the effectiveness of the South African National PMTCT programme. The primary objective was to measure rates of early MTCT of HIV at six weeks postpartum. The secondary objective was to periodically estimate coverage of key PMTCT interventions and services (e.g., HIV testing, CD4 cell count testing, infant antiretroviral (ARV) prophylaxis, infant feeding counselling).South African Medical Research Council, National Department of Health South Africa and PEPFAR/US Centers for Disease Control & Prevention, UNICE

JITANA: A modern hybrid program analysis framework for android platforms

Security vetting of Android apps is often performed under tight time constraints (e.g., a few minutes). As such, vetting activities must be performed “at speed”, when an app is submitted for distribution or a device is analyzed for malware. Existing static and dynamic program analysis approaches are not feasible for use in security analysis tools because they require a much longer time to operate than security analysts can afford. There are two factors that limit the performance and efficiency of current analysis approaches. First, existing approaches analyze only one app at a time. Finding security vulnerabilities in collaborative environments such as Android, however, requires collaborating apps to be analyzed simultaneously. Thus, existing approaches are not adequate when applied in this context. Second, existing static program analysis approaches tend to operate in a “closed world” fashion; therefore, they are not easily integrated with dynamic analysis processes to efficiently produce hybrid analysis results within a given time constraint. In this work, we introduce JITANA, an efficient and scalable hybrid program analysis framework for Android. JITANA has been designed from the ground up to be used as a building block to construct efficient and scalable program analysis techniques. JITANA also operates in an open world fashion, so malicious code detected as part of dynamic analysis can be quickly analyzed and the analysis results can be seamlessly integrated with the original static analysis results. To illustrate JITANA’s capability, we used it to analyze a large collection of apps simultaneously to identify potential collaborations among apps. We have also constructed several analysis techniques on top of JITANA and we use these to perform security vetting under four realistic scenarios. The results indicate that JITANA is scalable and robust; it can effectively and efficiently analyze complex apps including Facebook, Pokémon Go, and Pandora that the state-of-the-art approach cannot handle. In addition, we constructed a visualization engine as a plugin for JITANA to provide real-time feedback on code coverage to help analysts assess their vetting efforts. Such feedback can lead analysts to hard to reach code segments that may need further analysis. Finally we illustrate the effectiveness of JITANA in detecting and analyzing dynamically loaded code. Supplementary material attached below

Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa.

BACKGROUND: Loss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level, across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of HIV-related care. The latter could serve as a marker of knowledge, access or disclosure. METHODS: Secondary analysis of data gathered about HIV positive children, participating in an HIV-exposed infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV infected children were identified by total nucleic acid polymerase chain reaction using standardized procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV positive infant population, who were treated as a case series in this analysis. Data from interviews conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive diagnosis) were analysed. RESULTS: Of the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and 1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks, and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26 years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83% of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented recent CD4 cell count, the median was 346.8 cell/mm3. Four mothers (4.0%) self-reported having had TB. Only 59 (58.4%) HIV positive infants returned for an exit interview after their HIV diagnosis; there were no statistically significant differences in baseline characteristics between HIV positive infants who returned for an exit interview and those who did not. Amongst HIV positive infants who returned for an exit interview, only two HIV positive infants (3.4%) were reportedly receiving triple antiretroviral therapy (ART). If we assume that all HIV positive children who did not return for their exit interview received ART, then ART uptake amongst these HIV positive children < 18 months would be 43.6%. CONCLUSIONS: Early ART uptake amongst children aged 15 months and below was low. This raises questions about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children, and more work is needed to measure progress with infant ART initiation at primary care level since 2014

Modeling the influence of Twitter in reducing and increasing the spread of influenza epidemics

In this paper we present compartmentalized neuron arraying (CNA) microfluidic circuits for the preparation of neuronal networks using minimal cellular inputs (10–100-fold less than existing systems). The approach combines the benefits of microfluidics for precision single cell handling with biomaterial patterning for the long term maintenance of neuronal arrangements. A differential flow principle was used for cell metering and loading along linear arrays. An innovative water masking technique was developed for the inclusion of aligned biomaterial patterns within the microfluidic environment. For patterning primary neurons the technique involved the use of meniscus-pinning micropillars to align a water mask for plasma stencilling a poly-amine coating. The approach was extended for patterning the human SH-SY5Y neuroblastoma cell line using a poly(ethylene glycol) (PEG) back-fill and for dopaminergic LUHMES neuronal precursors by the further addition of a fibronectin coating. The patterning efficiency Epatt was &gt;75% during lengthy in chip culture, with ~85% of the outgrowth channels occupied by neurites. Neurons were also cultured in next generation circuits which enable neurite guidance into all outgrowth channels for the formation of extensive inter-compartment networks. Fluidic isolation protocols were developed for the rapid and sustained treatment of the different cellular and sub-cellular compartments. In summary, this research demonstrates widely applicable microfluidic methods for the construction of compartmentalized brain models with single cell precision. These minimalistic ex vivo tissue constructs pave the way for high throughput experimentation to gain deeper insights into pathological processes such as Alzheimer and Parkinson Diseases, as well as neuronal development and function in health

Efficient parallel and out of core algorithms for constructing large bi-directed de Bruijn graphs

<p>Abstract</p> <p>Background</p> <p>Assembling genomic sequences from a set of overlapping reads is one of the most fundamental problems in computational biology. Algorithms addressing the assembly problem fall into two broad categories <b>- </b>based on the data structures which they employ. The first class uses an overlap/string graph and the second type uses a de Bruijn graph. However with the recent advances in short read sequencing technology, de Bruijn graph based algorithms seem to play a vital role in practice. Efficient algorithms for building these massive de Bruijn graphs are very essential in large sequencing projects based on short reads. In an earlier work, an <it>O</it>(<it>n/p</it>) time parallel algorithm has been given for this problem. Here <it>n </it>is the size of the input and <it>p </it>is the number of processors. This algorithm enumerates all possible bi-directed edges which can overlap with a node and ends up generating Θ(<it>n</it>Σ) messages (Σ being the size of the alphabet).</p> <p>Results</p> <p>In this paper we present a Θ(<it>n/p</it>) time parallel algorithm with a communication complexity that is equal to that of parallel sorting and is not sensitive to Σ. The generality of our algorithm makes it very easy to extend it even to the out-of-core model and in this case it has an optimal I/O complexity of <inline-formula><m:math name="1471-2105-11-560-i1" xmlns:m="http://www.w3.org/1998/Math/MathML"><m:mrow><m:mo>Θ</m:mo><m:mo stretchy="false">(</m:mo><m:mfrac><m:mrow><m:mi>n</m:mi><m:mi>log</m:mi><m:mo stretchy="false">(</m:mo><m:mi>n</m:mi><m:mo>/</m:mo><m:mi>B</m:mi><m:mo stretchy="false">)</m:mo></m:mrow><m:mrow><m:mi>B</m:mi><m:mi>log</m:mi><m:mo stretchy="false">(</m:mo><m:mi>M</m:mi><m:mo>/</m:mo><m:mi>B</m:mi><m:mo stretchy="false">)</m:mo></m:mrow></m:mfrac><m:mo stretchy="false">)</m:mo></m:mrow></m:math></inline-formula> (<it>M </it>being the main memory size and <it>B </it>being the size of the disk block). We demonstrate the scalability of our parallel algorithm on a SGI/Altix computer. A comparison of our algorithm with the previous approaches reveals that our algorithm is faster <b>- </b>both asymptotically and practically. We demonstrate the scalability of our sequential out-of-core algorithm by comparing it with the algorithm used by VELVET to build the bi-directed de Bruijn graph. Our experiments reveal that our algorithm can build the graph with a constant amount of memory, which clearly outperforms VELVET. We also provide efficient algorithms for the bi-directed chain compaction problem.</p> <p>Conclusions</p> <p>The bi-directed de Bruijn graph is a fundamental data structure for any sequence assembly program based on Eulerian approach. Our algorithms for constructing Bi-directed de Bruijn graphs are efficient in parallel and out of core settings. These algorithms can be used in building large scale bi-directed de Bruijn graphs. Furthermore, our algorithms do not employ any all-to-all communications in a parallel setting and perform better than the prior algorithms. Finally our out-of-core algorithm is extremely memory efficient and can replace the existing graph construction algorithm in VELVET.</p

An approach for evaluating early and long term mother-to-child transmission of HIV (MTCT) in low and middle income countries: a South African experience

Abstract Background Eliminating mother-to-child transmission of HIV is a global public health target. Robust, feasible methodologies to measure population level impact of programmes to prevent mother-to-child transmission of HIV (PMTCT) are needed in high HIV prevalence settings. We present a summary of the protocol of the South African PMTCT Evaluation (SAPMTCTE) with its revision over three repeated rounds of the survey, 2010–2014. Methods Three cross sectional surveys (2010, 2011–2012 and 2012–2013) were conducted in 580 primary health care immunisation service points randomly selected after stratified multistage probability proportional to size sampling. All infants aged 4–8 weeks receiving their six-week immunisation at a sampled facility on the day of the visit were eligible to participate. Trained research nurses conducted interviews and took infant dried blood spot (iDBS) samples for HIV enzyme immunoassay (EIA) and total nucleic acid polymerase chain reaction (PCR) testing. Interviews were conducted using mobile phones and iDBS were sent to the National Health Laboratory for testing. All findings were adjusted for study design, non-response, and weighted for number of South African live-birth in each study round. In 2012 a national closed cohort of these 4 to 8-week old infants testing EIA positive (HIV Exposed Infants) from the 2012–2013 cross-sectional survey was established to estimate longer-term PMTCT impact to 18 months. Follow-up analyses were to estimate weighted cumulative MTCT until 18 months, postnatal MTCT from 6 weeks until 18 months and a combined outcome of MTCT-or-death, using a competing risks model, with death as a competing risk. HIV-free survival was defined as a child surviving and HIV-negative up to 18 months or last visit seen. A weighted cumulative incidence analysis was conducted, adjusting for survey design effects. Discussion In the absence of robust high-quality routine medical recording systems, in the context of a generalised HIV epidemic, national surveys can be used to monitor PMTCT effectiveness; however, monitoring long-term outcomes nationally is difficult due to poor retention in care

Post-critical set and non existence of preserved meromorphic two-forms

We present a family of birational transformations in $CP_2$ depending on two, or three, parameters which does not, generically, preserve meromorphic two-forms. With the introduction of the orbit of the critical set (vanishing condition of the Jacobian), also called ``post-critical set'', we get some new structures, some "non-analytic" two-form which reduce to meromorphic two-forms for particular subvarieties in the parameter space. On these subvarieties, the iterates of the critical set have a polynomial growth in the \emph{degrees of the parameters}, while one has an exponential growth out of these subspaces. The analysis of our birational transformation in $CP_2$ is first carried out using Diller-Favre criterion in order to find the complexity reduction of the mapping. The integrable cases are found. The identification between the complexity growth and the topological entropy is, one more time, verified. We perform plots of the post-critical set, as well as calculations of Lyapunov exponents for many orbits, confirming that generically no meromorphic two-form can be preserved for this mapping. These birational transformations in $CP_2$, which, generically, do not preserve any meromorphic two-form, are extremely similar to other birational transformations we previously studied, which do preserve meromorphic two-forms. We note that these two sets of birational transformations exhibit totally similar results as far as topological complexity is concerned, but drastically different results as far as a more ``probabilistic'' approach of dynamical systems is concerned (Lyapunov exponents). With these examples we see that the existence of a preserved meromorphic two-form explains most of the (numerical) discrepancy between the topological and probabilistic approach of dynamical systems.Comment: 34 pages, 7 figure

Genomic Signatures of Cooperation and Conflict in the Social Amoeba

Molecular evolution analyses reveal the history of social conflict Genes that mediate social conflict show signatures of frequency-dependent selection Balanced polymorphisms suggest that cheating may be stable and endemic Cooperative systems are susceptible to invasion by selfish individuals that profit from receiving the social benefits but fail to contribute. These so-called cheaters can have a fitness advantage in the laboratory, but it is unclear whether cheating provides an important selective advantage in nature. We used a population genomic approach to examine the history of genes involved in cheating behaviors in the social amoeba Dictyostelium discoideum, testing whether these genes experience rapid evolutionary change as a result of conflict over spore-stalk fate. Candidate genes and surrounding regions showed elevated polymorphism, unusual patterns of linkage disequilibrium, and lower levels of population differentiation, but they did not show greater between-species divergence. The signatures were most consistent with frequency-dependent selection acting to maintain multiple alleles, suggesting that conflict may lead to stalemate rather than an escalating arms race. Our results reveal the evolutionary dynamics of cooperation and cheating and underscore how sequence-based approaches can be used to elucidate the history of conflicts that are difficult to observe directly

Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014

Abstract Background Since 2001 the South African guidelines to improve child health and prevent vertical HIV transmission recommended frequent infant follow-up with HIV testing at 18 months postpartum. We sought to understand non-attendance at scheduled follow-up study visits up to 18 months, and for the 18-month infant HIV test amongst a nationally representative sample of HIV exposed uninfected (HEU) infants from a high HIV-prevalence African setting. Methods Secondary analysis of data drawn from a nationally representative observational cohort study (conducted during October 2012 to September 2014) of HEU infants and their primary caregivers was undertaken. Participants were eligible (N = 2650) if they were 4–8 weeks old and HEU at enrolment. All enrolled infants were followed up every 3 months up to 18 months. Each follow-up visit was scheduled to coincide with each child’s routine health visit, where possible. The denominator at each time point comprised HEU infants who were alive and HIV-free at the previous visit. We assessed baseline maternal and early HIV care characteristics associated with the frequency of ‘Missed visits’ (MV-frequency), using a negative binomial regression model adjusting for the follow-up time in the study, and associated with missed visits at 18 months (18-month MV) using a logistic regression model. Results The proportion of eligible infants with MV was lowest at 3 months (32.7%) and 18 months (31.0%) and highest at 12 months (37.6%). HIV-positive mothers not on triple antiretroviral therapy (ART) by 6-weeks postpartum had a significantly increased occurrence rate of ‘MV-frequency’ (adjusted incidence rate ratio, 1.2 (95% confidence interval (CI), 1.1–1.4), p  24 years had a significantly reduced rate of ‘MV-frequency’ (p ≤ 0.01) and risk of ‘18-month-MV’ (p < 0.01) compared to younger women. Shorter travel time to health facility lowered the occurrence of ‘MV-frequency’ (p ≤ 0.004). Conclusion Late initiation of maternal ART and infant prophylaxis under the Option- A policy and extended travel time to clinics (measured at 6 weeks postpartum), contributed to higher postnatal MV rates. Mothers older than 24 years had lower MV rates. Targeted interventions may be needed during the current PMTCT Option B+ (lifelong ART to pregnant and lactating women at HIV diagnosis) to circumvent these risk factors and reduce missed visits during HIV-care