Size Matters: The Number of Prostitutes and the Global HIV/AIDS Pandemic

Background. HIV/AIDS prevalence rates across countries of the world vary more than 500-fold from.06 % in Hungary to 33.4% in Swaziland. One of the most cited research papers in the field, utilizing cross country regression analysis to analyze other correlates with this HIV prevalence data, is flawed in that it weights each country’s results by the country’s population. Methodology/Principal Findings. Based on cross-country linear and multiple regressions using newly gathered data from UNAIDS, the number of female commercial sex workers as a percentage of the female adult population is robustly positively correlated with countrywide HIV/AIDS prevalence levels. Confirming earlier studies, female illiteracy levels, gender illiteracy differences and income inequality within countries are also significantly positively correlated with HIV/AIDS levels. Muslims as a percentage of the population, itself highly correlated with country circumcision rates and previously found to be negatively correlated with HIV/AIDS prevalence, is insignificant when the percentage of commercial sex workers in a population is included in the analysis. Conclusions/Significance. This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries. An explanation is offered for why Africa has been hit the hardest by the AIDS pandemic and why there appears to be very little correlation between HIV/AIDS infection rates and country wealth

Impact of Implementing Antenatal Syphilis Point-of-Care Testing on Maternal Mortality in KwaZulu-Natal, South Africa: An Interrupted Time Series Analysis.

BACKGROUND: Syphilis infection has been associated with an increased risk of HIV infection during pregnancy which poses greater risk for maternal mortality, and antenatal syphilis point-of-care (POC) testing has been introduced to improve maternal and child health outcomes. There is limited evidence on the impact of syphilis POC testing on maternal outcomes in high HIV prevalent settings. We used syphilis POC testing as a model to evaluate the impact of POC diagnostics on the improvement of maternal mortality in KwaZulu-Natal, South Africa. METHODS: We extracted 132 monthly data points on the number of maternal deaths in facilities and number of live births in facilities for 12 tertiary healthcare facilities in KwaZulu-Natal (KZN), South Africa from 2004 to 2014 from District Health Information System (DHIS) health facility archived. We employed segmented Poisson regression analysis of interrupted time series to assess the impact of the exposure on maternal mortality ratio (MMR) before and after the implementation of antenatal syphilis POC testing. We processed and analyzed data using Stata Statistical Software: Release 13. (Stata, Corp LP, College Station, TX, USA). RESULTS: The provincial average annual maternal mortality ratio (MMR) was estimated at 176.09 ± 43.92 ranging from a minimum of 68.48 to maximum of 225.49 per 100,000 live births. The data comprised 36 temporal points before the introduction of syphilis POC test exposure and 84 after the introduction in primary health care clinics in KZN. The average annual MMR for KZN from 2004 to 2014 was estimated at 176.09 ± 43.92. A decrease in MMR level was observed during 2008 after syphilis POC test implementation, followed by a rise during 2009. Analysis of the MMR trend estimates a significant 1.5% increase in MMR trends during the period before implementation and 1.3% increase after implementation of syphilis POC testing (p < 0.001). CONCLUSION: Although our finding suggests a brief reduction in the MMR trend after the implementation of antenatal syphilis POC testing, a continued increase in syphilis rates is seen in KwaZulu-Natal, South Africa. The study used one of the most powerful quasi-experimental research methods, segmented Poisson regression analysis of interrupted time series to model the impact of syphilis POC on maternal outcome. The study finding requires confirmation by use of more rigorous primary study design

Table 1. Quick reference data Symbol Parameter Conditions Min Typ Max Unit VDS drain-source voltage Tj = 25 °C

1. General description P-channel enhancement mode Field-Effect Transistor (FET) in a leadless ultra small DFN1010D-3 (SOT1215) Surface-Mounted Device (SMD) plastic package using Trench MOSFET technology. 2. Features and benefits • Trench MOSFET technology • Leadless ultra small and ultra thin SMD plastic package: 1.1 × 1.0 × 0.37 mm • Exposed drain pad for excellent thermal conduction • ElectroStatic Discharge (ESD) protection 1 kV HBM • Drain-source on-state resistance RDSon = 100 m

Entrustable Professional Activities (EPAs) for Global Health

Purpose As global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings. Method In 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low-to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-Type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains. Results Twenty-Two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability. Conclusions EPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions

Event categories in the EDELWEISS WIMP search experiment

Four categories of events have been identified in the EDELWEISS-I dark matter experiment using germanium cryogenic detectors measuring simultaneously charge and heat signals. These categories of events are interpreted as electron and nuclear interactions occurring in the volume of the detector, and electron and nuclear interactions occurring close to the surface of the detectors(10-20 mu-m of the surface). We discuss the hypothesis that low energy surface nuclear recoils,which seem to have been unnoticed by previous WIMP searches, may provide an interpretation of the anomalous events recorded by the UKDMC and Saclay NaI experiments. The present analysis points to the necessity of taking into account surface nuclear and electron recoil interactions for a reliable estimate of background rejection factors.Comment: 11 pages, submitted to Phys. Lett.

Background discrimination capabilities of a heat and ionization germanium cryogenic detector

The discrimination capabilities of a 70 g heat and ionization Ge bolometer are studied. This first prototype has been used by the EDELWEISS Dark Matter experiment, installed in the Laboratoire Souterrain de Modane, for direct detection of WIMPs. Gamma and neutron calibrations demonstrate that this type of detector is able to reject more than 99.6% of the background while retaining 95% of the signal, provided that the background events distribution is not biased towards the surface of the Ge crystal. However, the 1.17 kg.day of data taken in a relatively important radioactive environment show an extra population slightly overlapping the signal. This background is likely due to interactions of low energy photons or electrons near the surface of the crystal, and is somewhat reduced by applying a higher charge-collecting inverse bias voltage (-6 V instead of -2 V) to the Ge diode. Despite this contamination, more than 98% of the background can be rejected while retaining 50% of the signal. This yields a conservative upper limit of 0.7 event.day^{-1}.kg^{-1}.keV^{-1}_{recoil} at 90% confidence level in the 15-45 keV recoil energy interval; the present sensitivity appears to be limited by the fast ambient neutrons. Upgrades in progress on the installation are summarized.Comment: Submitted to Astroparticle Physics, 14 page

TOPEX/POSEIDON operational orbit determination results using global positioning satellites

Results of operational orbit determination, performed as part of the TOPEX/POSEIDON (T/P) Global Positioning System (GPS) demonstration experiment, are presented in this article. Elements of this experiment include the GPS satellite constellation, the GPS demonstration receiver on board T/P, six ground GPS receivers, the GPS Data Handling Facility, and the GPS Data Processing Facility (GDPF). Carrier phase and P-code pseudorange measurements from up to 24 GPS satellites to the seven GPS receivers are processed simultaneously with the GDPF software MIRAGE to produce orbit solutions of T/P and the GPS satellites. Daily solutions yield subdecimeter radial accuracies compared to other GPS, LASER, and DORIS precision orbit solutions

Light and electron microscopical observations of the effects of high-density lipoprotein on growth of Plasmodium falciparum in vitro

Author Posting. © Cambridge University Press, 2004. This article is posted here by permission of Cambridge University Press for personal use, not for redistribution. The definitive version was published in Parasitology 128 (2004): 577-584, doi:10.1017/S0031182004005025.Human serum high-density lipoprotein (HDL) is necessary and sufficient for the short-term maintenance of Plasmodium falciparum in in vitro culture. However, at high concentrations it is toxic to the parasite. A heat-labile component is apparently responsible for the stage-specific toxicity to parasites within infected erythrocytes 12–42 h after invasion, i.e. during trophozoite maturation. The effects of HDL on parasite metabolism (as determined by nucleic acid synthesis) are evident at about 30 h after invasion. Parasites treated with HDL show gross abnormalities by light and electron microscopy.Professor Hajduk was supported by NIH. Professor Day was supported by a Research Leave Fellowship from The Wellcome Trust. Dr Imrie and Ms Carter were supported by Programme Grant funding awarded to Professor Day from The Wellcome Trust. Dr Ferguson was supported by an equipment grant from The Wellcome Trust

The EDELWEISS Experiment : Status and Outlook

The EDELWEISS Dark Matter search uses low-temperature Ge detectors with heat and ionisation read- out to identify nuclear recoils induced by elastic collisions with WIMPs from the galactic halo. Results from the operation of 70 g and 320 g Ge detectors in the low-background environment of the Modane Underground Laboratory (LSM) are presented.Comment: International Conference on Dark Matter in Astro and Particle Physics (Dark 2000), Heidelberg, Germany, 10-16 Jul 2000, v3 minor revision

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Introduction: South African guidelines recommend two rapid tests for diagnosing human immunodeficiency virus (HIV) using the serial HIV testing algorithm, but the accuracy and compliance to this algorithm is unknown in rural clinics. We evaluated the accuracy of HIV rapid testing and the time to receiving test results among pregnant women in rural KwaZulu-Natal (KZN).Method: We observed the accuracy of rapid HIV testing algorithms for 208 consenting antenatal patients accessing voluntary HIV testing services in nine rural primary healthcare (PHC) clinics in KZN. A PHC-based HIV counsellor obtained finger-prick whole blood from each participant to perform rapid testing using the Advanced Quality™ One Step anti-HIV (1&amp;2) and/or ABON™ HIV 1/2/O Tri-Line HIV test. A research nurse obtained venous blood for an enzyme-linked immunosorbent assay (ELISA) HIV test, which is the gold standard diagnostic test. We recorded the time of receipt of HIV test results for each test.Results: Among 208 pregnant women with a mean age of 26 years, 72 women from nine rural PHC clinics were identified as HIV-positive by two rapid tests with an HIV-prevalence of 35% (95% Bayesian credibility intervals [BCI]: 28% – 41%). Of the 208 patients, 135 patients from six clinics were tested with the serial HIV testing algorithm. The estimated sensitivity and specificity for the 135 participants were 100% (95% confidence interval [CI]: 93% – 100%) and 99% (CI: 95% – 100%), respectively. The positive predictive value and negative predictive value were estimated at 98% (CI: 94% – 100%) and 95% (CI: 88% – 99%), respectively. All women received their HIV rapid test results within 20 min of testing. Test stock-out resulted in poor test availability at point-of-care, preventing performance of a second HIV test in three out of nine PHC clinics in rural KZN.Conclusion: Despite the poor compliance with national guidelines for HIV rapid testing services, HIV rapid test results provided to pregnant women in rural PHC clinics in KZN were generally accurate and timely. Test stock-out was shown to be one of the barriers to test availability in rural PHC clinics, resulting in poor compliance with guidelines. We recommend a compulsory confirmation HIV rapid test for all HIV-negative test results obtained from pregnant patients in rural and resource-limited settings