How to design and evaluate interventions to improve outcomes for patients with multimorbidity

Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems

Diffuse inverse Compton and synchrotron emission from dark matter annihilations in galactic satellites

Annihilating dark matter particles produce roughly as much power in electrons and positrons as in gamma ray photons. The charged particles lose essentially all of their energy to inverse Compton and synchrotron processes in the galactic environment. We discuss the diffuse signature of dark matter annihilations in satellites of the Milky Way (which may be optically dark with few or no stars), providing a tail of emission trailing the satellite in its orbit. Inverse Compton processes provide X-rays and gamma rays, and synchrotron emission at radio wavelengths might be seen. We discuss the possibility of detecting these signals with current and future observations, in particular EGRET and GLAST for the gamma rays.Comment: 13 pages, 5 figure

A review of the mineral potential of Liberia

The Republic of Liberia in West Africa is underlain mostly by Precambrian rocks of Archaean (Liberian) age in the west and of Proterozoic (Eburnean) age in the east. By analogy with similar terranes elsewhere in the world, and in West Africa in particular, the geology of Liberia is favourable for the occurrence of deposits of a wide range of metals and industrial minerals, including gold, iron ore, diamonds, base metals, bauxite, manganese, fluorspar, kyanite and phosphate. Known gold deposits, mostly orogenic in style, occur widely and are commonly associated with north-east-trending regional shear zones. Gold mining commenced at the New Liberty deposit in western Liberia in 2015, while significant gold resources have also been identified at several other sites in both Archaean and Proterozoic terranes. Liberia has large resources of itabirite-type iron ores, most of which are located in the Liberian terrane, and was the largest producer in Africa prior to the onset of civil war in 1989. Production of iron ore is currently restricted to a single mine, Yekepa, in the Nimba Range. Other important deposits, some of them previously mined, include Bong, the Western Cluster, Putu and Goe Fantro. There is a long history of alluvial diamond production in western and central Liberia, together with more than 160 known occurrences of kimberlite. Most of the known kimberlites occur in three clusters of small pipes and abundant dykes, located at Kumgbor, Mano Godua and Weasua, close to the border with Sierra Leone. Many of these are considered to be part of a single province that includes Jurassic age diamondiferous kimberlites in Sierra Leone and Guinea. Deposits and occurrences of a wide range of other metals and industrial minerals are also known. Several of these have been worked on a small scale in the past, mainly by artisanal miners, but most are poorly known in detail with sub-surface information available at only a few localities. By comparison with most other countries in West Africa, the geology of Liberia is poorly known and there has been very little systematic exploration carried out for most commodities other than gold, iron ore and diamonds since the 1960s and 1970s. Further detailed field and laboratory investigations using modern techniques are required to properly evaluate the potential for the occurrence of economic deposits of many minerals and metals in a variety of geological settings. Digital geological, geochemical, geophysical and mineral occurrence datasets, including new national airborne geophysical survey data, provide a sound basis for the identification of new exploration targets, but in almost every part of the country there is a need for new and more detailed geological surveys to underpin mineral exploration

The cosmic ray positron excess and neutralino dark matter

Using a new instrument, the HEAT collaboration has confirmed the excess of cosmic ray positrons that they first detected in 1994. We explore the possibility that this excess is due to the annihilation of neutralino dark matter in the galactic halo. We confirm that neutralino annihilation can produce enough positrons to make up the measured excess only if there is an additional enhancement to the signal. We quantify the `boost factor' that is required in the signal for various models in the Minimal Supersymmetric Standard Model parameter space, and study the dependence on various parameters. We find models with a boost factor greater than 30. Such an enhancement in the signal could arise if we live in a clumpy halo. We discuss what part of supersymmetric parameter space is favored (in that it gives the largest positron signal), and the consequences for other direct and indirect searches of supersymmetric dark matter.Comment: 11 pages, 6 figures, matches published version (PRD

Designing Equitable Antiretroviral Allocation Strategies in Resource-Constrained Countries

BACKGROUND: Recently, a global commitment has been made to expand access to antiretrovirals (ARVs) in the developing world. However, in many resource-constrained countries the number of individuals infected with HIV in need of treatment will far exceed the supply of ARVs, and only a limited number of health-care facilities (HCFs) will be available for ARV distribution. Deciding how to allocate the limited supply of ARVs among HCFs will be extremely difficult. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria. METHODS AND FINDINGS: Here we use operations research techniques, and we show how to determine the optimal strategy for allocating ARVs among HCFs in order to satisfy the equitable criterion that each individual infected with HIV has an equal chance of receiving ARVs. We present a novel spatial mathematical model that includes heterogeneity in treatment accessibility. We show how to use our theoretical framework, in conjunction with an equity objective function, to determine an optimal equitable allocation strategy (OEAS) for ARVs in resource-constrained regions. Our equity objective function enables us to apply the egalitarian principle of equity with respect to access to health care. We use data from the detailed ARV rollout plan designed by the government of South Africa to determine an OEAS for the province of KwaZulu–Natal. We determine the OEAS for KwaZulu–Natal, and we then compare this OEAS with two other ARV allocation strategies: (i) allocating ARVs only to Durban (the largest urban city in KwaZulu–Natal province) and (ii) allocating ARVs equally to all available HCFs. In addition, we compare the OEAS to the current allocation plan of the South African government (which is based upon allocating ARVs to 17 HCFs). We show that our OEAS significantly improves equity in treatment accessibility in comparison with these three ARV allocation strategies. We also quantify how the size of the catchment region surrounding each HCF, and the number of HCFs utilized for ARV distribution, alters the OEAS and the probability of achieving equity in treatment accessibility. We calculate that in order to achieve the greatest degree of treatment equity for individuals with HIV in KwaZulu–Natal, the ARVs should be allocated to 54 HCFs and each HCF should serve a catchment region of 40 to 60 km. CONCLUSION: Our OEAS would substantially improve equality in treatment accessibility in comparison with other allocation strategies. Furthermore, our OEAS is extremely different from the currently planned strategy. We suggest that our novel methodology be used to design optimal ARV allocation strategies for resource-constrained countries

The global atmospheric electrical circuit and climate

Evidence is emerging for physical links among clouds, global temperatures, the global atmospheric electrical circuit and cosmic ray ionisation. The global circuit extends throughout the atmosphere from the planetary surface to the lower layers of the ionosphere. Cosmic rays are the principal source of atmospheric ions away from the continental boundary layer: the ions formed permit a vertical conduction current to flow in the fair weather part of the global circuit. Through the (inverse) solar modulation of cosmic rays, the resulting columnar ionisation changes may allow the global circuit to convey a solar influence to meteorological phenomena of the lower atmosphere. Electrical effects on non-thunderstorm clouds have been proposed to occur via the ion-assisted formation of ultra-fine aerosol, which can grow to sizes able to act as cloud condensation nuclei, or through the increased ice nucleation capability of charged aerosols. Even small atmospheric electrical modulations on the aerosol size distribution can affect cloud properties and modify the radiative balance of the atmosphere, through changes communicated globally by the atmospheric electrical circuit. Despite a long history of work in related areas of geophysics, the direct and inverse relationships between the global circuit and global climate remain largely quantitatively unexplored. From reviewing atmospheric electrical measurements made over two centuries and possible paleoclimate proxies, global atmospheric electrical circuit variability should be expected on many timescale

Relativistic Laser-Matter Interaction and Relativistic Laboratory Astrophysics

The paper is devoted to the prospects of using the laser radiation interaction with plasmas in the laboratory relativistic astrophysics context. We discuss the dimensionless parameters characterizing the processes in the laser and astrophysical plasmas and emphasize a similarity between the laser and astrophysical plasmas in the ultrarelativistic energy limit. In particular, we address basic mechanisms of the charged particle acceleration, the collisionless shock wave and magnetic reconnection and vortex dynamics properties relevant to the problem of ultrarelativistic particle acceleration.Comment: 58 pages, 19 figure

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR