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Integration of family planning services into HIV care clinics: Results one year after a cluster randomized controlled trial in Kenya.

OBJECTIVES:To determine if integration of family planning (FP) and HIV services led to increased use of more effective contraception (i.e. hormonal and permanent methods, and intrauterine devices) and decreased pregnancy rates. DESIGN:Cohort analysis following cluster randomized trial, when the Kenya Ministry of Health led integration of the remaining control (delayed integration) sites and oversaw integrated services at the original intervention (early integration) sites. SETTING:Eighteen health facilities in Kenya. SUBJECTS:Women aged 18-45 receiving care: 5682 encounters at baseline, and 11628 encounters during the fourth quarter of year 2. INTERVENTION:"One-stop shop" approach to integrating FP and HIV services. MAIN OUTCOME MEASURES:Use of more effective contraceptive methods and incident pregnancy across two years of follow-up. RESULTS:Following integration of FP and HIV services at the six delayed integration clinics, use of more effective contraception increased from 31.7% to 44.2% of encounters (+12.5%; Prevalence ratio (PR) = 1.39 (1.19-1.63). Among the twelve early integration sites, the proportion of encounters at which women used more effective contraceptive methods was sustained from the end of the first to the second year of follow-up (37.5% vs. 37.0%). Pregnancy incidence including all 18 integrated sites in year two declined in comparison to the control arm in year one (rate ratio: 0.72; 95% CI 0.60-0.87). CONCLUSIONS:Integration of FP services into HIV clinics led to a sustained increase in the use of more effective contraceptives and decrease in pregnancy incidence 24 months following implementation of the integrated service model. TRIAL REGISTRATION:ClinicalTrials.gov NCT01001507

Finite Element Modeling of Resonance in Polycrystalline Materials for Resonance Ultrasound Spectroscopy

Validation of models that predict the performance of aerospace engine materials depends on the ability to obtain accurate single crystal elastic constants. Resonance Ultrasound Spectroscopy (RUS) is a nondestructive technique in which the natural resonances of a material are utilized to obtain these constants. Traditional RUS utilizes an analytic approach to determine the resonance frequencies of a specimen given an initial guess set of elastic constants. A nonlinear optimization process then fits the elastic constants to experimentally measured data. This approach is limited both in its ability to handle specimens with complex geometry and to handle polycrystalline materials. These more complex scenarios can be approached by utilizing a finite element forward model to obtain sample resonances. A finite element forward model is being developed utilizing COMSOL Multiphysics to compute specimen resonance frequencies. Elastic constants are obtained utilizing a bounded nonlinear optimization routine in MATLAB by way of COMSOL\u27s LiveLink for MATLAB interface. Validation of this forward model has been performed on single crystal specimens, including a nickel superalloy parallelepiped and a fused silica cylinder with a chamfer, ultimately producing lower residual error after optimization than the traditional RUS approach. Model validation is also being performed on a Nickel Aluminide (NiAl) bicrystal. This paper presents the details of this validation process. Also presented is an examination of error sources and the impact they can play in the ability to accurately obtain elastic constants

Improvements in the South African HIV care cascade: findings on 90-90-90 targets from successive population-representative surveys in North West Province.

IntroductionTo achieve epidemic control of HIV by 2030, countries aim to meet 90-90-90 targets to increase knowledge of HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression by 2020. We assessed the progress towards these targets from 2014 to 2016 in South Africa as expanded treatment policies were introduced using population-representative surveys.MethodsData were collected in January to March 2014 and August to November 2016 in Dr. Ruth Segomotsi Mompati District, North West Province. Each multi-stage cluster sample included 46 enumeration areas (EA), a target of 36 dwelling units (DU) per EA, and a single resident aged 18 to 49 per DU. Data collection included behavioural surveys, rapid HIV antibody testing and dried blood spot collection. We used weighted general linear regression to evaluate differences in the HIV care continuum over time.ResultsOverall, 1044 and 971 participants enrolled in 2014 and 2016 respectively with approximately 77% undergoing HIV testing. Despite increases in reported testing, known status among people living with HIV (PLHIV) remained similar at 68.7% (95% Confidence Interval (CI) = 60.9-75.6) in 2014 and 72.8% (95% CI = 63.6-80.4) in 2016. Men were consistently less likely than women to know their status. Among those with known status, PLHIV on ART increased significantly from 80.9% (95% CI = 71.9-87.4) to 91.5% (95% CI = 84.4-95.5). Viral suppression (<5000 copies/mL using DBS) among those on ART increased significantly from 55.0% (95% CI = 39.6-70.4) in 2014 to 81.4% (95% CI = 72.0-90.8) in 2016. Among all PLHIV an estimated 72.0% (95% CI = 63.8-80.1) of women and 45.8% (95% CI = 27.0-64.7) of men achieved viral suppression by 2016.ConclusionsOver a period during which fixed-dose combination was introduced, ART eligibility expanded, and efforts to streamline treatment were implemented, major improvements in the second and third 90-90-90 targets were achieved. Achieving the first 90 target will require targeted and improved testing models for men

Results of analyses performed on basalt adjacent to penetrators emplaced into volcanic rock at Amboy, California, April 1976

The physical and chemical modifications found in the basalt after impact of four penetrators were studied. Laboratory analyses show that mineralogical and elemental changes are produced in the powdered and crushed basalt immediately surrounding the penetrator. Optical microscopy studies of material next to the skin of the penetrator revealed a layer, 0-2 mm thick, of glass and abraded iron alloy mixed with fractured mineral grains of basalt. Elemental analysis of the 0-2 mm layer revealed increased concentrations of Fe, Cr, Ni, No, and Mn, and reduced concentrations of Mg, Al, Si, and Ca. The Fe, Cr, Ni, and Mo were in fragments abraded from the penetrator. Mineralogical changes occurring in the basalt sediment next to the penetrator include the introduction of micron-size grains of alpha-iron, magnetite, and hematite. The newly formed silicate minerals include metastable phases of silica (tridymite and cristobalite). An increased concentration of Fe, Cr, Ni, and Mo occurred in the 2-mm to 1-cm layer of penetrator no. 1, which impacted at the highest velocity. No elemental concentration increase was noted for penetrators nos. 2 and 3 in the 2-mm to 1-cm layer. Contaminants introduced by the penetrator occur up to 1 cm away from the penetrator's skin. Although volatile elements do migrate and new minerals are formed during the destruction of host minerals in the crushed rock, no changes were observed beyond the 1-cm distance

Neuroimaging evidence implicating cerebellum in support of sensory/cognitive processes associated with thirst.

Recent studies implicate the cerebellum, long considered strictly a motor control structure, in cognitive, sensory, and affective phenomenon. The cerebellum, a phylogenetically ancient structure, has reciprocal ancient connections to the hypothalamus, a structure important in vegetative functions. The present study investigated whether the cerebellum was involved in vegetative functions and the primal emotions engendered by them. Using positron emission tomography, we examined the effects on the cerebellum of the rise of plasma sodium concentration and the emergence of thirst in 10 healthy adults. The correlation of regional cerebral blood flow with subjects' ratings of thirst showed major activation in the vermal central lobule. During the development of thirst, the anterior and posterior quadrangular lobule, lingula, and the vermis were activated. At maximum thirst and then during irrigation of the mouth with water to alleviate dryness, the cerebellum was less activated. However, 3 min after drinking to satiation, the anterior quadrangular lobule and posterior cerebellum were highly activated. The increased cerebellar activity was not related to motor behavior as this did not occur. Instead, responses in ancient cerebellar regions (vermis, fastigal nucleus, archicerebellum) may be more directly related to vegetative and affective aspects of thirst experiences, whereas activity in neocerebellar (posterior) regions may be related to sensory and cognitive aspects. Moreover, the cerebellum is apparently not involved in the computation of thirst per se but rather is activated during changes in thirst/satiation state when the brain is "vigilant" and is monitoring its sensory systems. Some neocerebellar activity may also reflect an intentionality for gratification by drinking inherent in the consciousness of thirst