The long winding road of opioid substitution therapy implementation in South-East Asia: challenges to scale up

In South-East Asia Region (SEAR) there were an estimated 400, 000 - 500,000 people who inject drugs (PWID). HIV prevalence among PWID was commonly 20% and higher in Indonesia, Thailand, Myanmar, and some regions of India. Opioid substitution therapy (OST) has been implemented as an important HIV prevention intervention in the Region. Various key challenges and barriers to scale up of OST exist: pervasive stigma and discrimination towards PWID; crimilization of drug use overshadowing a public health response; lack of political will and national commitment; low financial investment; focus towards traditional treatment model of detoxification and rehabilitation; low dose of OST; and poor monitoring and evaluation of programmes.Local evidence has highlighted that OST can be successful within the Asian context. Such evidence should be utilized more widely to advocate for policy and increased political commitment to ensure OST reaches a substantial greater number of drug users than currently exists

The impact of injecting networks on hepatitis C transmission and treatment in people who inject drugs

With the development of new highly efficacious direct acting antiviral treatments (DAAs) for hepatitis C (HCV), the concept of treatment as prevention is gaining credence. To date the majority of mathematical models assume perfect mixing with injectors having equal contact with all other injectors. This paper explores how using a networks based approach to treat people who inject drugs (PWID) with DAAs affects HCV prevalence. Method: Using observational data we parameterized an Exponential Random Graph Model containing 524 nodes. We simulated transmission of HCV through this network using a discrete time, stochastic transmission model. The effect of five treatment strategies on the prevalence of HCV was investigated; two of these strategies were 1) treat randomly selected nodes and 2) “treat your friends” where an individual is chosen at random for treatment and all their infected neighbours are treated. Results: As treatment coverage increases, HCV prevalence at 10 years reduces for both the high efficacy and low efficacy treatment. Within each set of parameters, the “treat your friends” strategy performed better than the random strategy being most marked for higher efficacy treatment. For example over 10 years of treating 25 per 1000 PWID, the prevalence drops from 50% to 40% for the random strategy, and to 33% for the “treat your friends” strategy (6.5% difference, 95% CI 5.1 – 8.1%). Discussion: “Treat your friends” is a feasible means of utilising network strategies to improve treatment efficiency. In an era of highly efficacious and highly tolerable treatment such an approach will benefit not just the individual but the community more broadly by reducing the prevalence of HCV amongst PWID

Hepatitis C transmission and treatment as prevention - The role of the injecting network

Background: The hepatitis C virus (HCV) epidemic is a major health issue; in most developed countries it is driven by people who inject drugs (PWID). Injecting networks powerfully influence HCV transmission. In this paper we provide an overview of 10 years of research into injecting networks and HCV, culminating in a network-based approach to provision of direct-acting antiviral therapy. Methods: Between 2005 and 2010 we followed a cohort of 413 PWID, measuring HCV incidence, prevalence and injecting risk, including network-related factors. We developed an individual-based HCV transmission model, using it to simulate the spread of HCV through the empirical social network of PWID. In addition, we created an empirically grounded network model of injecting relationships using exponential random graph models (ERGMs), allowing simulation of realistic networks for investigating HCV treatment and intervention strategies. Our empirical work and modelling underpins the TAP Study, which is examining the feasibility of community-based treatment of PWID with DAAs. Results: We observed incidence rates of HCV primary infection and reinfection of 12.8 per 100 person-years (PY) (95%CI: 7.7-20.0) and 28.8 per 100 PY (95%CI: 15.0-55.4), respectively, and determined that HCV transmission clusters correlated with reported injecting relationships. Transmission modelling showed that the empirical network provided some protective effect, slowing HCV transmission compared to a fully connected, homogenous PWID population. Our ERGMs revealed that treating PWID and all their contacts was the most effective strategy and targeting treatment to infected PWID with the most contacts the least effective. Conclusion: Networks-based approaches greatly increase understanding of HCV transmission and will inform the implementation of treatment as prevention using DAAs

An Automated Method for the Detection and Extraction of HI Self-Absorption in High-Resolution 21cm Line Surveys

We describe algorithms that detect 21cm line HI self-absorption (HISA) in large data sets and extract it for analysis. Our search method identifies HISA as spatially and spectrally confined dark HI features that appear as negative residuals after removing larger-scale emission components with a modified CLEAN algorithm. Adjacent HISA volume-pixels (voxels) are grouped into features in (l,b,v) space, and the HI brightness of voxels outside the 3-D feature boundaries is smoothly interpolated to estimate the absorption amplitude and the unabsorbed HI emission brightness. The reliability and completeness of our HISA detection scheme have been tested extensively with model data. We detect most features over a wide range of sizes, linewidths, amplitudes, and background levels, with poor detection only where the absorption brightness temperature amplitude is weak, the absorption scale approaches that of the correlated noise, or the background level is too faint for HISA to be distinguished reliably from emission gaps. False detection rates are very low in all parts of the parameter space except at sizes and amplitudes approaching those of noise fluctuations. Absorption measurement biases introduced by the method are generally small and appear to arise from cases of incomplete HISA detection. This paper is the third in a series examining HISA at high angular resolution. A companion paper (Paper II) uses our HISA search and extraction method to investigate the cold atomic gas distribution in the Canadian Galactic Plane Survey.Comment: 39 pages, including 14 figure pages; to appear in June 10 ApJ, volume 626; figure quality significantly reduced for astro-ph; for full resolution, please see http://www.ras.ucalgary.ca/~gibson/hisa/cgps1_survey

Mutational activation of BRAF confers sensitivity to transforming growth factor beta inhibitors in human cancer cells

Recent data implicate elevated transforming growth factor-β (TGFβ) signalling in BRAF inhibitor drug-resistance mechanisms, but the potential for targeting TGFβ signalling in cases of advanced melanoma has not been investigated. We show that mutant BRAFV600E confers an intrinsic dependence on TGFβ/TGFβ receptor 1 (TGFBR1) signalling for clonogenicity of murine melanocytes. Pharmacological inhibition of the TGFBR1 blocked the clonogenicity of human mutant BRAF melanoma cells through SMAD4-independent inhibition of mitosis, and also inhibited metastasis in xenografted zebrafish. When investigating the therapeutic potential of combining inhibitors of mutant BRAF and TGFBR1, we noted that unexpectedly, low-dose PLX-4720 (a vemurafenib analogue) promoted proliferation of drug-naïve melanoma cells. Pharmacological or pharmacogenetic inhibition of TGFBR1 blocked growth promotion and phosphorylation of SRC, which is frequently associated with vemurafenib-resistance mechanisms. Importantly, vemurafenib-resistant patient derived cells retained sensitivity to TGFBR1 inhibition, suggesting that TGFBR1 could be targeted therapeutically to combat the development of vemurafenib drug-resistance

Association of the Host Immune Response with Protection Using a Live Attenuated African Swine Fever Virus Model

Citation: Carlson, J.; O’Donnell, V.; Alfano, M.; Velazquez Salinas, L.; Holinka, L.G.; Krug, P.W.; Gladue, D.P.; Higgs, S.; Borca, M.V. Association of the Host Immune Response with Protection Using a Live Attenuated African Swine Fever Virus Model. Viruses 2016, 8, 291.African swine fever (ASF) is a lethal hemorrhagic disease of swine caused by a double-stranded DNA virus, ASF virus (ASFV). There is no vaccine to prevent the disease and current control measures are limited to culling and restricting animal movement. Swine infected with attenuated strains are protected against challenge with a homologous virulent virus, but there is limited knowledge of the host immune mechanisms generating that protection. Swine infected with Pretoriuskop/96/4 (Pret4) virus develop a fatal severe disease, while a derivative strain lacking virulence-associated gene 9GL (Pret4Δ9GL virus) is completely attenuated. Swine infected with Pret4Δ9GL virus and challenged with the virulent parental virus at 7, 10, 14, 21, and 28 days post infection (dpi) showed a progressive acquisition of protection (from 40% at 7 dpi to 80% at 21 and 28 dpi). This animal model was used to associate the presence of host immune response (ASFV-specific antibody and interferon (IFN)-γ responses, or specific cytokine profiles) and protection against challenge. With the exception of ASFV-specific antibodies in survivors challenged at 21 and 28 dpi, no association between the parameters assessed and protection could be established. These results, encompassing data from 65 immunized swine, underscore the complexity of the system under study, suggesting that protection relies on the concurrence of different host immune mechanisms

Episodic Memory and Appetite Regulation in Humans

Psychological and neurobiological evidence implicates hippocampal-dependent memory processes in the control of hunger and food intake. In humans, these have been revealed in the hyperphagia that is associated with amnesia. However, it remains unclear whether 'memory for recent eating' plays a significant role in neurologically intact humans. In this study we isolated the extent to which memory for a recently consumed meal influences hunger and fullness over a three-hour period. Before lunch, half of our volunteers were shown 300 ml of soup and half were shown 500 ml. Orthogonal to this, half consumed 300 ml and half consumed 500 ml. This process yielded four separate groups (25 volunteers in each). Independent manipulation of the 'actual' and 'perceived' soup portion was achieved using a computer-controlled peristaltic pump. This was designed to either refill or draw soup from a soup bowl in a covert manner. Immediately after lunch, self-reported hunger was influenced by the actual and not the perceived amount of soup consumed. However, two and three hours after meal termination this pattern was reversed - hunger was predicted by the perceived amount and not the actual amount. Participants who thought they had consumed the larger 500-ml portion reported significantly less hunger. This was also associated with an increase in the 'expected satiation' of the soup 24-hours later. For the first time, this manipulation exposes the independent and important contribution of memory processes to satiety. Opportunities exist to capitalise on this finding to reduce energy intake in humans

PYTHIA 6.4 Physics and Manual

The PYTHIA program can be used to generate high-energy-physics `events', i.e. sets of outgoing particles produced in the interactions between two incoming particles. The objective is to provide as accurate as possible a representation of event properties in a wide range of reactions, within and beyond the Standard Model, with emphasis on those where strong interactions play a role, directly or indirectly, and therefore multihadronic final states are produced. The physics is then not understood well enough to give an exact description; instead the program has to be based on a combination of analytical results and various QCD-based models. This physics input is summarized here, for areas such as hard subprocesses, initial- and final-state parton showers, underlying events and beam remnants, fragmentation and decays, and much more. Furthermore, extensive information is provided on all program elements: subroutines and functions, switches and parameters, and particle and process data. This should allow the user to tailor the generation task to the topics of interest.Comment: 576 pages, no figures, uses JHEP3.cls. The code and further information may be found on the PYTHIA web page: http://www.thep.lu.se/~torbjorn/Pythia.html Changes in version 2: Mistakenly deleted section heading for "Physics Processes" reinserted, affecting section numbering. Minor updates to take into account referee comments and new colour reconnection option

A dual role for SAMHD1 in regulating HBV cccDNA and RT-dependent particle genesis

Chronic hepatitis B is one of the world's unconquered diseases with more than 240 million infected subjects at risk of developing liver disease and hepatocellular carcinoma. Hepatitis B virus reverse transcribes pre-genomic RNA to relaxed circular DNA (rcDNA) that comprises the infectious particle. To establish infection of a naïve target cell, the newly imported rcDNA is repaired by host enzymes to generate covalently closed circular DNA (cccDNA), which forms the transcriptional template for viral replication. SAMHD1 is a component of the innate immune system that regulates deoxyribonucleoside triphosphate levels required for host and viral DNA synthesis. Here, we show a positive role for SAMHD1 in regulating cccDNA formation, where KO of SAMHD1 significantly reduces cccDNA levels that was reversed by expressing wild-type but not a mutated SAMHD1 lacking the nuclear localization signal. The limited pool of cccDNA in infected Samhd1 KO cells is transcriptionally active, and we observed a 10-fold increase in newly synthesized rcDNA-containing particles, demonstrating a dual role for SAMHD1 to both facilitate cccDNA genesis and to restrict reverse transcriptase-dependent particle genesis