Cost-Effectiveness of Genotype Testing for Primary Resistance in Brazil

Objective: HIV genotype-resistance testing can help identify more effective antiretroviral treatment (ART) regimens for patients, substantially increasing the likelihood of viral suppression and immune recovery. We sought to evaluate the cost-effectiveness of genotype-resistance testing before first-line ART initiation in Brazil. Design: We used a previously published microsimulation model of HIV disease (CEPAC-International) and data from Brazil to compare the clinical impact, costs, and cost-effectiveness of initial genotype testing (Genotype) with no initial genotype testing (No genotype). Methods: Model parameters were derived from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute and from published data, using Brazilian sources whenever possible. Baseline patient characteristics included 69% male, mean age of 36 years (SD, 10 years), mean CD4 count of 347 per microliter (SD, 300/µL) at ART initiation, annual ART costs from 2012 US $1400 to US$13,400, genotype test cost of US $230, and primary resistance prevalence of 4.4$12,300. Results: Compared with No genotype, Genotype increased life expectancy from 18.45 to 18.47 years and reduced lifetime cost from US $45,000 to$44,770; thus, in the base case, Genotype was cost saving. Genotype was cost-effective at primary resistance prevalence as low as 1.4% and remained cost-effective when subsequent-line ART costs decreased to 30% of baseline value. Cost-inefficient results were observed only when simultaneously holding multiple parameters to extremes of their plausible ranges. Conclusions: Genotype-resistance testing in ART-naive individuals in Brazil will improve survival and decrease costs and should be incorporated into HIV treatment guidelines in Brazil

Kepler Presearch Data Conditioning I - Architecture and Algorithms for Error Correction in Kepler Light Curves

Kepler provides light curves of 156,000 stars with unprecedented precision. However, the raw data as they come from the spacecraft contain significant systematic and stochastic errors. These errors, which include discontinuities, systematic trends, and outliers, obscure the astrophysical signals in the light curves. To correct these errors is the task of the Presearch Data Conditioning (PDC) module of the Kepler data analysis pipeline. The original version of PDC in Kepler did not meet the extremely high performance requirements for the detection of miniscule planet transits or highly accurate analysis of stellar activity and rotation. One particular deficiency was that astrophysical features were often removed as a side-effect to removal of errors. In this paper we introduce the completely new and significantly improved version of PDC which was implemented in Kepler SOC 8.0. This new PDC version, which utilizes a Bayesian approach for removal of systematics, reliably corrects errors in the light curves while at the same time preserving planet transits and other astrophysically interesting signals. We describe the architecture and the algorithms of this new PDC module, show typical errors encountered in Kepler data, and illustrate the corrections using real light curve examples.Comment: Submitted to PASP. Also see companion paper "Kepler Presearch Data Conditioning II - A Bayesian Approach to Systematic Error Correction" by Jeff C. Smith et a

Overview of the Kepler Science Processing Pipeline

The Kepler Mission Science Operations Center (SOC) performs several critical functions including managing the ~156,000 target stars, associated target tables, science data compression tables and parameters, as well as processing the raw photometric data downlinked from the spacecraft each month. The raw data are first calibrated at the pixel level to correct for bias, smear induced by a shutterless readout, and other detector and electronic effects. A background sky flux is estimated from ~4500 pixels on each of the 84 CCD readout channels, and simple aperture photometry is performed on an optimal aperture for each star. Ancillary engineering data and diagnostic information extracted from the science data are used to remove systematic errors in the flux time series that are correlated with these data prior to searching for signatures of transiting planets with a wavelet-based, adaptive matched filter. Stars with signatures exceeding 7.1 sigma are subjected to a suite of statistical tests including an examination of each star's centroid motion to reject false positives caused by background eclipsing binaries. Physical parameters for each planetary candidate are fitted to the transit signature, and signatures of additional transiting planets are sought in the residual light curve. The pipeline is operational, finding planetary signatures and providing robust eliminations of false positives.Comment: 8 pages, 3 figure

Discovery and Rossiter-McLaughlin Effect of Exoplanet Kepler-8b

We report the discovery and the Rossiter-McLaughlin effect of Kepler-8b, a transiting planet identified by the NASA Kepler Mission. Kepler photometry and Keck-HIRES radial velocities yield the radius and mass of the planet around this F8IV subgiant host star. The planet has a radius RP = 1.419 RJ and a mass, MP = 0.60 MJ, yielding a density of 0.26 g cm^-3, among the lowest density planets known. The orbital period is P = 3.523 days and orbital semima jor axis is 0.0483+0.0006/-0.0012 AU. The star has a large rotational v sin i of 10.5 +/- 0.7 km s^-1 and is relatively faint (V = 13.89 mag), both properties deleterious to precise Doppler measurements. The velocities are indeed noisy, with scatter of 30 m s^-1, but exhibit a period and phase consistent with the planet implied by the photometry. We securely detect the Rossiter-McLaughlin effect, confirming the planet's existence and establishing its orbit as prograde. We measure an inclination between the projected planetary orbital axis and the projected stellar rotation axis of lambda = -26.9 +/- 4.6 deg, indicating a moderate inclination of the planetary orbit. Rossiter-McLaughlin measurements of a large sample of transiting planets from Kepler will provide a statistically robust measure of the true distribution of spin-orbit orientations for hot jupiters in general.Comment: 26 pages, 8 figures, 2 tables; In preparation for submission to the Astrophysical Journa

Planetary Candidates Observed by Kepler, III: Analysis of the First 16 Months of Data

New transiting planet candidates are identified in sixteen months (May 2009 - September 2010) of data from the Kepler spacecraft. Nearly five thousand periodic transit-like signals are vetted against astrophysical and instrumental false positives yielding 1,091 viable new planet candidates, bringing the total count up to over 2,300. Improved vetting metrics are employed, contributing to higher catalog reliability. Most notable is the noise-weighted robust averaging of multi-quarter photo-center offsets derived from difference image analysis which identifies likely background eclipsing binaries. Twenty-two months of photometry are used for the purpose of characterizing each of the new candidates. Ephemerides (transit epoch, T_0, and orbital period, P) are tabulated as well as the products of light curve modeling: reduced radius (Rp/R*), reduced semi-major axis (d/R*), and impact parameter (b). The largest fractional increases are seen for the smallest planet candidates (197% for candidates smaller than 2Re compared to 52% for candidates larger than 2Re) and those at longer orbital periods (123% for candidates outside of 50-day orbits versus 85% for candidates inside of 50-day orbits). The gains are larger than expected from increasing the observing window from thirteen months (Quarter 1-- Quarter 5) to sixteen months (Quarter 1 -- Quarter 6). This demonstrates the benefit of continued development of pipeline analysis software. The fraction of all host stars with multiple candidates has grown from 17% to 20%, and the paucity of short-period giant planets in multiple systems is still evident. The progression toward smaller planets at longer orbital periods with each new catalog release suggests that Earth-size planets in the Habitable Zone are forthcoming if, indeed, such planets are abundant.Comment: Submitted to ApJS. Machine-readable tables are available at http://kepler.nasa.gov, http://archive.stsci.edu/kepler/results.html, and the NASA Exoplanet Archiv

Fast core rotation in red-giant stars revealed by gravity-dominated mixed modes

When the core hydrogen is exhausted during stellar evolution, the central region of a star contracts and the outer envelope expands and cools, giving rise to a red giant, in which convection occupies a large fraction of the star. Conservation of angular momentum requires that the cores of these stars rotate faster than their envelopes, and indirect evidence supports this. Information about the angular momentum distribution is inaccessible to direct observations, but it can be extracted from the effect of rotation on oscillation modes that probe the stellar interior. Here, we report the detection of non-rigid rotation in the interiors of red-giant stars by exploiting the rotational frequency splitting of recently detected mixed modes. We demonstrate an increasing rotation rate from the surface of the star to the stellar core. Comparing with theoretical stellar models, we conclude that the core must rotate at least ten times faster than the surface. This observational result confirms the theoretical prediction of a steep gradient in the rotation profile towards the deep stellar interior.Comment: to appear as a Letter to Natur

Seismic analysis of four solar-like stars observed during more than eight months by Kepler

Having started science operations in May 2009, the Kepler photometer has been able to provide exquisite data of solar-like stars. Five out of the 42 stars observed continuously during the survey phase show evidence of oscillations, even though they are rather faint (magnitudes from 10.5 to 12). In this paper, we present an overview of the results of the seismic analysis of 4 of these stars observed during more than eight months.Comment: 5 pages, 1 figure. To appear in the ASP proceedings of "The 61st Fujihara seminar: Progress in solar/stellar physics with helio- and asteroseismology", 13th-17th March 2011, Hakone, Japa

N348I in the Connection Domain of HIV-1 Reverse Transcriptase Confers Zidovudine and Nevirapine Resistance

Analyzing HIV sequences from a Canadian cohort, Gilda Tachedjian and colleagues identify a common mutation in a little-studied domain of reverse transcriptase that confers resistance to two drug classes

(2S*,5R*)-2,5-Dimethyl-1,4-bis(pyridin-2-ylmethyl)piperazine

The title compound, C18H24N4, resides on a crystallographic inversion centre, so that the asymmetric unit comprises one half-molecule. The piperazine ring adopts a chair conformation, with the mean planes of the two equatorial pyridine rings parallel to each other and separated by 2.54 (3) Å. No classical hydrogen bonds are observed