The Snow Border

Context. The study of the snow line is an important topic in several domains of astrophysics, and particularly for the evolution of proto-stellar environments and the formation of planets. Aims. The formation of the first layer of ice on carbon grains requires low temperatures compared to the temperature of evaporation (T > 100 K). This asymmetry generates a zone in which bare and icy dust grains coexist. Methods. We use Monte-Carlo simulations to describe the formation time scales of ice mantles on bare grains in protostellar disks and massive protostars environments. Then we analytically describe these two systems in terms of grain populations subject to infall and turbulence, and assume steady-state. Results. Our results show that there is an extended region beyond the snow line where icy and bare grains can coexist, in both proto-planetary disks and massive protostars. This zone is not negligible compared to the total size of the objects: on the order of 0.4 AU for proto-planetary disks and 5400 AU for high-mass protostars. Times to reach the steady-state are respectively es- timated from 10^2 to 10^5 yr. Conclusions. The presence of a zone, a so-called snow border, in which bare and icy grains co- exist can have a major impact on our knowledge of protostellar environments. From a theoretical point of view, the progression of icy grains to bare grains as the temperature increases, could be a realistic way to model hot cores and hot corinos. Also, in this zone, the formation of planetesimals will require the coagulation of bare and icy grains. Observationally, this zone allows high abundances of gas phase species at large scales, for massive protostars particularly, even at low temperatures (down to 50 K).Comment: accepted in A&

Smarter Programming of the Female Condom: Increasing Its Impact on HIV Prevention in the Developing World

The purpose of this study was to investigate the relative value of the female condom for HIV prevention within heterosexual relationships in the developing world. In the last ten years, the world has witnessed both historic financial commitments to HIV/AIDS and new prevention options, including biomedical prevention research, male circumcision, and a dramatic scale-up of voluntary counseling and testing. At the same time, where HIV remains at epidemic levels in many countries, there has been a growing commitment to treatment access alongside prevention programs. However, portions of populations, particularly youth and women, remain highly vulnerable to HIV infection. Accordingly, the global health community can benefit from a better understanding of how existing prevention options should be effectively and efficiently delivered to reduce HIV in the developing world. This report provides guidance for the global health community for considering how the female condom fits within the set of prevention interventions currently available

Tracing early evolutionary stages of high-mass star formation with molecular lines

Despite its major role in the evolution of the interstellar medium, the formation of high-mass stars (M > 10 Msol) is still poorly understood. Two types of massive star cluster precursors, the so-called Massive Dense Cores (MDCs), have been observed, which differ in their mid-infrared brightness. The origin of this difference is not established and could be the result of evolution, density, geometry differences, or a combination of these. We compare several molecular tracers of physical conditions (hot cores, shocks) observed in a sample of mid-IR weak emitting MDCs with previous results obtained in a sample of exclusively mid-IR bright MDCs. The aim is to understand the differences between these two types of object. We present single-dish observations of HDO, H2O-18, SO2 and CH3OH lines at lambda = 1.3 - 3.5 mm. We study line profiles and estimate abundances of these molecules, and use a partial correlation method to search for trends in the results. The detection rates of thermal emission lines are found to be very similar between mid-IR quiet and bright objects. The abundances of H2O, HDO (1E-13 to 1E-9 in the cold outer envelopes), SO2 and CH3OH differ from source to source but independently of their mid-IR flux. In contrast, the methanol class I maser emission, a tracer of outflow shocks, is found to be strongly anti-correlated with the 12 micron source brightnesses. The enhancement of the methanol maser emission in mid-IR quiet MDCs may indicate a more embedded nature. Since total masses are similar between the two samples, we suggest that the matter distribution is spherical around mid-IR quiet sources but flattened around mid-IR bright ones. In contrast, water emission is associated with objects containing a hot molecular core, irrespective of their mid-IR brightness. These results indicate that the mid-IR brightness of MDCs is an indicator of their evolutionary stage.Comment: 15 pages, 6 figures, 11 tables, accepted for publication in A&A the 11/06/201

The economics of psychedelic-assisted therapies: A research agenda

After a long hiatus, psychiatry is undergoing a resurgence of interest in psychedelic drugs as therapy for a wide range of mental health disorders Accumulating clinical evidence suggests substantial potential for psychedelics used in a therapeutic context, as treatment for, among other disorders, depression, post-traumatic stress disorder (PTSD), and addictions to tobacco, opioids and alcohol. As soon as 2024, powerful new therapeutic modalities could become available for individuals with mental health problems refractory to traditional therapies. Yet research has lagged on economic considerations, such as costs and cost-effectiveness, the economic effects of widespread implementation, pricing, and economic appraisal's methodological considerations relevant to psychedelic therapies. These issues are critical if psychedelic therapies are to become widely accessible. We describe six types of economic analyses and their rationale for decisions and planning including the needs of health care payers. We also outline desirable features of this research, including scientific rigor, long horizons, equity, and a global view

Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting

BACKGROUND: Consistent with observational studies, a randomized controlled intervention trial of adult male circumcision (MC) conducted in the general population in Orange Farm (OF) (Gauteng Province, South Africa) demonstrated a protective effect against HIV acquisition of 60%. The objective of this study is to present the first cost-effectiveness analysis of the use of MC as an intervention to reduce the spread of HIV in sub-Saharan Africa. METHODS AND FINDINGS: Cost-effectiveness was modeled for 1,000 MCs done within a general adult male population. Intervention costs included performing MC and treatment of adverse events. HIV prevalence was estimated from published estimates and incidence among susceptible subjects calculated assuming a steady-state epidemic. Effectiveness was defined as the number of HIV infections averted (HIA), which was estimated by dynamically projecting over 20 years the reduction in HIV incidence observed in the OF trial, including secondary transmission to women. Net savings were calculated with adjustment for the averted lifetime duration cost of HIV treatment. Sensitivity analyses examined the effects of input uncertainty and program coverage. All results were discounted to the present at 3% per year. For Gauteng Province, assuming full coverage of the MC intervention, with a 2005 adult male prevalence of 25.6%, 1,000 circumcisions would avert an estimated 308 (80% CI 189–428) infections over 20 years. The cost is $181 (80$117–$306) per HIA, and net savings are$2.4 million (80% CI $1.3 million to$3.6 million). Cost-effectiveness is sensitive to the costs of MC and of averted HIV treatment, the protective effect of MC, and HIV prevalence. With an HIV prevalence of 8.4%, the cost per HIA is $551 (80$344–$1,071) and net savings are$753,000 (80% CI $0.3 million to$1.2 million). Cost-effectiveness improves by less than 10% when MC intervention coverage is 50% of full coverage. CONCLUSIONS: In settings in sub-Saharan Africa with high or moderate HIV prevalence among the general population, adult MC is likely to be a cost-effective HIV prevention strategy, even when it has a low coverage. MC generates large net savings after adjustment for averted HIV medical costs

Outputs, cost and efficiency of public sector centres for prevention of mother to child transmission of HIV in Andhra Pradesh, India

<p>Abstract</p> <p>Background</p> <p>Prevention of mother to child transmission (PMTCT) is an important part of the effort to control HIV. PMTCT services are mostly provided at public sector government hospitals in India. Systematic data on the cost and efficiency of providing PMTCT services in India are not available readily for further planning.</p> <p>Methods</p> <p>Cost and output data were collected at 16 sampled PMTCT centres in the south Indian state of Andhra Pradesh using standardized methods. The services provided were analysed, and the relation of unit cost of services with scale was assessed.</p> <p>Results</p> <p>In the 2005–2006 fiscal year, 125,073 pregnant women received PMTCT services at the 16 centres (range 2,939 to 20,896, median 5,679). The overall HIV positive rate among those tested was 1.67%. Of the total economic cost, the major components were personnel (47.3%) and recurrent goods (31.7%). For the 16 PMTCT centres, the average economic cost per post-HIV-test counselled pregnant woman was Indian Rupees (INR) 98.9 (US$2.23), ranging 2.7-fold from INR 71.4 (US$ 1.61) to INR 189.9 (US$4.29). The economic cost per mother-neonate pair who received nevirapine had a higher variation, ranging 41-fold for the 16 centres from INR 4,354 (US$ 98) to INR 179,175 (US$4,047), average INR 10,210 (US$ 231), with very high unit cost at some centres where HIV prevalence among pregnant women and the total volume of services were both low. Scale had a significant inverse relation with both of the unit costs, per post-HIV-test counselled pregnant woman and per mother-neonate pair who received nevirapine. In addition, HIV prevalence among pregnant women had a significant inverse relation with unit cost per mother-neonate pair who received nevirapine.</p> <p>Conclusion</p> <p>Although the variation between PMTCT centres for unit cost per post-HIV-test counselled pregnant woman was modest that per mother-neonate pair receiving nevirapine was over 40-fold. The extremely high unit cost for each mother-neonate pair receiving nevirapine at some centres suggests that the new approach of combining PMTCT services with voluntary counselling and testing services that has recently been started in India could potentially offer better efficiency.</p

Water in massive star-forming regions: HIFI observations of W3 IRS5

We present Herschel observations of the water molecule in the massive star-forming region W3 IRS5. The o-H17O 110-101, p-H18O 111-000, p-H2O 22 202-111, p-H2O 111-000, o-H2O 221-212, and o-H2O 212-101 lines, covering a frequency range from 552 up to 1669 GHz, have been detected at high spectral resolution with HIFI. The water lines in W3 IRS5 show well-defined high-velocity wings that indicate a clear contribution by outflows. Moreover, the systematically blue-shifted absorption in the H2O lines suggests expansion, presumably driven by the outflow. No infall signatures are detected. The p-H2O 111-000 and o-H2O 212-101 lines show absorption from the cold material (T ~ 10 K) in which the high-mass protostellar envelope is embedded. One-dimensional radiative transfer models are used to estimate water abundances and to further study the kinematics of the region. We show that the emission in the rare isotopologues comes directly from the inner parts of the envelope (T > 100 K) where water ices in the dust mantles evaporate and the gas-phase abundance increases. The resulting jump in the water abundance (with a constant inner abundance of 10^{-4}) is needed to reproduce the o-H17O 110-101 and p-H18O 111-000 spectra in our models. We estimate water abundances of 10^{-8} to 10^{-9} in the outer parts of the envelope (T < 100 K). The possibility of two protostellar objects contributing to the emission is discussed.Comment: Accepted for publication in the A&A HIFI special issu