The costs of HIV prevention for different target populations in Mumbai, Thane and Bangalore.

BACKGROUND: Avahan, the India AIDS Initiative, delivers HIV prevention services to high-risk populations at scale. Although the broad costs of such HIV interventions are known, to-date there has been little data available on the comparative costs of reaching different target groups, including female sex workers (FSWs), replace with 'high risk men who have sex with men (HR-MSM) and trans-genders. METHODS: Costs are estimated for the first three years of Avahan scale up differentiated by typology of female sex workers (brothel, street, home, lodge based, bar based), HR-MSM and transgenders in urban districts in India: Mumbai and Thane in Maharashtra and Bangalore in Karnataka. Financial and economic costs were collected prospectively from a provider perspective. Outputs were measured using data collected by the Avahan programme. Costs are presented in US$2008. RESULTS: Costs were found to vary substantially by target group. Non-governmental organisations (NGOs) working with transgender populations had a higher mean cost (US$116) per person reached compared to those dealing primarily with FSWs (US $75-96) and MSWs (US$90) by the end of year three of the programme in Mumbai. The mean cost of delivering the intervention to HR-MSMs (US $42) was higher than delivering it to FSWs (US$37) in Bangalore. The package of services delivered to each target group was similar, and our results suggest that cost variation is related to the target population size, the intensity of the programme (in terms of number of contacts made per year) and a number of specific issues related to each target group. CONCLUSIONS: Based on our data policy makers and program managers need to consider the ease of accessing high risk population when planning and budgeting for HIV prevention services for these populations and avoid funding programmes on the basis of target population size alone

Towards real time automated early gear failure detection

The ability to stop a gear fatigue test before catastrophic failure has many advantages. However, today, a widely accepted approach is not available. This case study applies a vibration-based condition monitoring methodology to detect early gear failures. The gear studied takes part in an all-wheel-drive drivetrain system. Vibration signals from four run-to-failure fatigue tests at two constant torque-speed combinations were used as input to time-synchronous averaging and autoregression model generation. The applied methodology shows promising results for early failure detection, and the process is feasible for implementation in an automated environment. Real time analysis is also possible since the autoregression model generates a healthy state TSA signal during the early testing stages. However, the time to failure detection varies with operating conditions, with low sensitivity at high-speed and low-torque conditions

Universal Economic Trends And The Role Of Digital Transformation For Sustainability

Necessity is the mother of innovation; this has been proved again. The Covid-19 has been put the entire global activities at nearly to halt. Major countries are experiencing slack in the economy. Significant sectors of the economy have been affected. Consider any domain they have been affected by the negative impact of Covid-19. Despite the negative impact and hope that has not been given up, we are observing transformation throughout different sectors to exit from the negative trend and maintain growth. In this, we are observing the significant role of digital transformation. Today primary keys of the economy are utilizing the digital solution to come out of this negative trend in growth and maintain consistency in the performance. Several digital solutions and ideas have recently been evolved to contribute to the digital transformation and keep leveraging the services. This transformation has been adding value to the economy, but it needs several issues to fulfill to be globally accepted. The paper highlights some significant impacts and solutions

Searching for rare and forbidden exclusive Higgs boson decays with the Atlas detector

Searches for Higgs and Z bosons decaying to an ω meson and a photon, and for Higgs bosons decaying to a K$^∗$ and a photon are discussed using proton collision data recorded by the ATLAS experiment at √s = 13 TeV between 2016 and 2018. The observed events are consistent with the expected background. The obtained 95% confidence level upper limit on the branching ratio for the H → ωγ decay using 89.5 fb$^{−1}$ of data is 1.0 ×10$^{−4}$ assuming a Standard Model Higgs Boson production. The analogous limit obtained for the Z → ωγ decay is 3.5 ×10${−7}$. The obtained upper limit for the H → K$^∗$γ decay is 8.9 ×10$^{−5}$, using 134 fb$^{−1}$ of data. The search for H → K$^∗$γ represents the first search for a flavour-violating exclusive decay of the Higgs boson

An overview of treatment options for COVID-19

Severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) which emerged in Wuhan initially as pneumonia of unknown origin in December 2019, later spread to whole world and became pandemic on 11th March, 2020. Many drugs have been proposed but are backed without clinical evidence. Scientific bodies are in the row to discover a reliable vaccine and effective drugs against the novel coronavirus. Many antiviral and anti-parasitic drugs which were thought to have some effect on Coronavirus disease 2019 (COVID-19) have been tried during the crisis but none have shown concrete evidence of action. Randomized clinical trials on the repurposed drugs are now registered under clinical trial registry to look at the safety profile and efficacy of the drugs to be used against SARS-CoV-2. Many meta-analyses are being conducted worldwide to frame evidence for the fight against this novel coronavirus. We are providing below a review of various drugs that have been tried for treatment of COVID-19 as well as different clinical trials which are underway

The effects of scale on the costs of targeted HIV prevention interventions among female and male sex workers, men who have sex with men and transgenders in India

BACKGROUND: The India AIDS Initiative (Avahan) project is involved in rapid scale-up of HIV-prevention interventions in high-risk populations. This study examines the cost variation of 107 non-governmental organisations (NGOs) implementing targeted interventions, over the start up (defined as period from project inception until services to the key population commenced) and first 2 years of intervention. METHODS: The Avahan interventions for female and male sex workers and their clients, in 62 districts of four southern states were costed for the financial years 2004/2005 and 2005/2006 using standard costing techniques. Data sources include financial and economic costs from the lead implementing partners (LPs) and subcontracted local implementing NGOs retrospectively and prospectively collected from a provider perspective. Ingredients and step-down allocation processes were used. Outcomes were measured using routinely collected project data. The average costs were estimated and a regression analysis carried out to explore causes of cost variation. Costs were calculated in US$2006. RESULTS: The total number of registered people was 134,391 at the end of 2 years, and 124,669 had used STI services during that period. The median average cost of Avahan programme for this period was$76 per person registered with the project. Sixty-one per cent of the cost variation could be explained by scale (positive association), number of NGOs per district (negative), number of LPs in the state (negative) and project maturity (positive) (p<0.0001). CONCLUSIONS: During rapid scale-up in the initial phase of the Avahan programme, a significant reduction in average costs was observed. As full scale-up had not yet been achieved, the average cost at scale is yet to be realised and the extent of the impact of scale on costs yet to be captured. Scale effects are important to quantify for planning resource requirements of large-scale interventions. The average cost after 2 years is within the range of global scale-up costs estimates and other studies in India

Factors which influence the cardiac surgeon's decision not to operate on patients referred for consideration of surgery

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to document what proportion of patients referred for consideration of cardiac surgery are turned down, the reasons given for not operating and also to evaluate what happens to those patients who do not undergo surgery.</p> <p>Methods</p> <p>382 elective patients referred for consideration of cardiac surgery to one of six consultant cardiac surgeons at Wythenshawe Hospital during a one year period from were included in the study. Data for those patients who underwent an operation were collected prospectively in a cardiac surgery database. The case notes of those patients who did not undergo an operation were reviewed to establish reasons given by surgeons for not operating. Patients were followed up to determine vital status at the end of the study period.</p> <p>Results</p> <p>333 (87.2%) patients underwent an operation and 49 (12.8%) did not. 68% of patients turned down were thought to be too high-risk. 14% of patients did not fulfill symptomatic or prognostic criteria for surgery and in 8% of patients coronary artery surgery was thought ineffective due to poor distal vessels. 6% of patients declined an operation and 4% were thought to be more suitable for coronary angioplasty. Patients turned down for surgery had more renal dysfunction (p = 0.017), respiratory disease (p < 0.001) and peripheral vascular disease (p < 0.001), were more likely to have undergone prior heart surgery (p < 0.001) and to have poor left ventricular function (p = 0.003). Patients turned down for surgery had significantly higher EuroSCORE values compared to patients who underwent an operation: 5 versus 4 (p = 0.006). Freedom from death in the patients turned down for surgery at 1-, 6-, 12- and 24-months was 95.9%, 91.8%, 83.7% and 71.4% respectively, compared with 97.9%, 96.7%, 96.4% and 94.5% for the patients who underwent an operation (p < 0.001 [log-rank]). 14 of the 15 deaths that occurred in the turned down group occurred in the category considered too high-risk for surgery.</p> <p>Conclusion</p> <p>12.8% of patients referred for consideration of cardiac surgery did not undergo an operation. Two thirds of patients not accepted for surgery were thought too high risk. Those patients who did not undergo an operation had a significantly worse mortality.</p

Reliable State Machines: A Framework for Programming Reliable Cloud Services

Building reliable applications for the cloud is challenging because of unpredictable failures during a program\u27s execution. This paper presents a programming framework, called Reliable State Machines (RSMs), that offers fault-tolerance by construction. In our framework, an application comprises several (possibly distributed) RSMs that communicate with each other via messages, much in the style of actor-based programming. Each RSM is fault-tolerant by design, thereby offering the illusion of being "always-alive". An RSM is guaranteed to process each input request exactly once, as one would expect in a failure-free environment. The RSM runtime automatically takes care of persisting state and rehydrating it on a failover. We present the core syntax and semantics of RSMs, along with a formal proof of failure-transparency. We provide a .NET implementation of the RSM framework for deploying services to Microsoft Azure. We carry out an extensive performance evaluation on micro-benchmarks to show that one can build high-throughput applications with RSMs. We also present a case study where we rewrite a significant part of a production cloud service using RSMs. The resulting service has simpler code and exhibits production-grade performance