Influence of lithophysae geometry on mechanical properties of Hydro-Stone®

85 percent of YM drift tunnels will be constructed in lithophysal volcanic tuff. Rock behavior depends on porosity. Limited experimental data exists to characterize rock porosity and dependencies on properties such as σc , E, and n

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study.

BackgroundChronic kidney disease (CKD) may be common among individuals living in sub-Saharan Africa due to the confluence of CKD risk factors and genetic predisposition.MethodsWe ascertained the prevalence of CKD and its risk factors among a sample of 3,686 participants of a population-based HIV trial in rural Uganda and Kenya. Prevalent CKD was defined as a serum creatinine-based estimated glomerular filtration rate <60 mL/min/1.73m2 or proteinuria (urine dipstick ≥1+). We used inverse-weighting to estimate the population prevalence of CKD, and multivariable log-link Poisson models to assess the associations of potential risk factors with CKD.ResultsThe estimated CKD prevalence was 6.8% (95% CI 5.7-8.1%) overall and varied by region, being 12.5% (10.1-15.4%) in eastern Uganda, 3.9% (2.2-6.8%) in southwestern Uganda and 3.7% (2.7-5.1%) in western Kenya. Risk factors associated with greater CKD prevalence included age ≥60 years (adjusted prevalence ratio [aPR] 3.5 [95% CI 1.9-6.5] compared with age 18-29 years), HIV infection (aPR 1.6 [1.1-2.2]), and residence in eastern Uganda (aPR 3.9 [2.6-5.9]). However, two-thirds of individuals with CKD did not have HIV, diabetes, or hypertension as risk factors. Furthermore, we noted many individuals who did not have proteinuria had dipstick positive leukocyturia or hematuria.ConclusionThe prevalence of CKD is appreciable in rural East Africa and there are considerable regional differences. Conventional risk factors appear to only explain a minority of cases, and leukocyturia and hematuria were common, highlighting the need for further research into understanding the nature of CKD in sub-Saharan Africa

Population levels and geographical distribution of HIV RNA in rural Ugandan and Kenyan communities, including serodiscordant couples: a cross-sectional analysis.

BackgroundAs sub-Saharan Africa transitions to a new era of universal antiretroviral therapy (ART), up-to-date assessments of population-level HIV RNA suppression are needed to inform interventions to optimise ART delivery. We sought to measure population viral load metrics to assess viral suppression and characterise demographic groups and geographical locations with high-level detectable viraemia in east Africa.MethodsThe Sustainable East Africa Research in Community Health (SEARCH) study is a cluster-randomised controlled trial of an HIV test-and-treat strategy in 32 rural communities in Uganda and Kenya, selected on the basis of rural setting, having an approximate population of 10 000 people, and being within the catchment area of a President's Emergency Plan for AIDS Relief-supported HIV clinic. During the baseline population assessment in the SEARCH study, we did baseline HIV testing and HIV RNA measurement. We analysed stable adult (aged ≥15 years) community residents. We defined viral suppression as a viral load of less than 500 copies per mL. To assess geographical sources of transmission risk, we established the proportion of all adults (both HIV positive and HIV negative) with a detectable viral load (local prevalence of viraemia). We defined transmission risk hotspots as geopolitical subunits within communities with an at least 5% local prevalence of viraemia. We also assessed serodiscordant couples, measuring the proportion of HIV-positive partners with detectable viraemia. The SEARCH study is registered with ClinicalTrials.gov, number NCT01864603.FindingsBetween April 2, 2013, and June 8, 2014, of 303 461 stable residents, we enumerated 274 040 (90·3%), of whom 132 030 (48·2%) were adults. Of these, 117 711 (89·2%) had their HIV status established, of whom 11 964 (10·2%) were HIV positive. Of these, we measured viral load in 8828 (73·8%) people. Viral suppression occurred in 3427 (81·6%) of 4202 HIV-positive adults on ART and 4490 (50·9%) of 8828 HIV-positive adults. Regional viral suppression among HIV-positive adults occurred in 881 (48·2%) of 1827 people in west Uganda, 516 (45·0%) of 1147 in east Uganda, and 3093 (52·8%) of 5854 in Kenya. Transmission risk hotspots occurred in three of 21 parishes in west Uganda and none in east Uganda and in 24 of 26 Kenya geopolitical subunits. In Uganda, 492 (2·9%) of 16 874 couples were serodiscordant: in 287 (58·3%) of these couples, the HIV-positive partner was viraemic (and in 69 [14·0%], viral load was >100 000 copies per mL). In Kenya, 859 (10·0%) of 8616 couples were serodiscordant: in 445 (53·0%) of these couples, the HIV-positive partner was viraemic (and in 129 [15%], viral load was >100 000 copies per mL).InterpretationBefore the start of the SEARCH trial, 51% of east African HIV-positive adults had viral suppression, reflecting ART scale-up efforts to date. Geographical hotspots of potential HIV transmission risk and detectable viraemia among serodiscordant couples warrant intensified interventions.FundingNational Institute of Allergy and Infectious Diseases (National Institutes of Health) and the President's Emergency Plan for AIDS Relief

Scholarship Series: KSU Faculty Showcase

Kennesaw State University School of Music presents Faculty Showcase, a KSU School of Music Scholarship Series concert.https://digitalcommons.kennesaw.edu/musicprograms/1534/thumbnail.jp

High rates of viral suppression in adults and children with high CD4+ counts using a streamlined ART delivery model in the SEARCH trial in rural Uganda and Kenya.

INTRODUCTION: The 2015 WHO recommendation of antiretroviral therapy (ART) for all HIV-positive persons calls for treatment initiation in millions of persons newly eligible with high CD4+ counts. Efficient and effective care models are urgently needed for this population. We evaluated clinical outcomes of asymptomatic HIV-positive adults and children starting ART with high CD4+ counts using a novel streamlined care model in rural Uganda and Kenya. METHODS: In the 16 intervention communities of the HIV test-and-treat Sustainable East Africa Research for Community Health Study (NCT01864603), all HIV-positive individuals irrespective of CD4 were offered ART (efavirenz [EFV]/tenofovir disoproxil fumarate + emtricitabine (FTC) or lamivudine (3TC). We studied adults (≥fifteen years) with CD4 ≥ 350/μL and children (two to fourteen years) with CD4 > 500/μL otherwise ineligible for ART by country guidelines. Clinics implemented a patient-centred streamlined care model designed to reduce patient-level barriers and maximize health system efficiency. It included (1) nurse-conducted visits with physician referral of complex cases, (2) multi-disease chronic care (including for hypertension/diabetes), (3) patient-centred, friendly staff, (4) viral load (VL) testing and counselling, (5) three-month return visits and ART refills, (6) appointment reminders, (7) tiered tracking for missed appointments, (8) flexible clinic hours (outside routine schedule) and (9) telephone access to clinicians. Primary outcomes were 48-week retention in care, viral suppression (% with measured week 48 VL ≤ 500 copies/mL) and adverse events. Results Overall, 972 HIV-positive adults with CD4+ ≥ 350/μL initiated ART with streamlined care. Patients were 66% female and had median age thirty-four years (IQR, 28-42), CD4+ 608/μL (IQR, 487-788/μL) and VL 6775 copies/mL (IQR, <500-37,003 c/mL). At week 48, retention was 92% (897/972; 2 died/40 moved/8 withdrew/4 transferred care/21/964 [2%] were lost to follow-up). Viral suppression occurred in 778/838 (93%) and 800/972 (82%) in intention-to-treat analysis. Grade III/IV clinical/laboratory adverse events were rare: 95 occurred in 74/972 patients (7.6%). Only 8/972 adults (0.8%) switched ART from EFV to lopinavir (LPV) (n = 2 for dizziness, n = 2 for gynaecomastia, n = 4 for other reasons). Among 83 children, week 48 retention was 89% (74/83), viral suppression was 92% (65/71) and grade III/IV adverse events occurred in 4/83 (4.8%). CONCLUSIONS: Using a streamlined care model, viral suppression, retention and ART safety were high among asymptomatic East African adults and children with high CD4+ counts initiating treatment. CLINICAL TRIAL NUMBER: NCT01864603

Welcome - NPS Academics Overview [video]

AY12 Compass Seminar for New Faculty, 18 September 201

The Future of Naval Postgraduate School - Setting the Stage

The Naval Postgraduate School embarked this year on a quest to imagine the future and what its place might be in that future. While currently an acknowledged expert in national security, to excel even more in the years to come, NPS must study current trends, estimate the future ones and determine its path. Given sufficient flexibility, NPS has the opportunity to create a future where the talents of faculty, students and staff are fully realized; where the education is unquestionably the best and where research impacts every facet of the security of the world in which we live. In preparation for updating its strategic plan in 2012, the Naval Postgraduate School established a Committee on the Future to assess national security and academic trends, define future challenges, and recommend actions to ensure continued mission success. Committee members representing industry,academia, government and the NPS Board of Advisors divided their effort into nine working groups: Trends, Education and Research, Faculty, Students, Organization, Funding, Facilities, Information Technology, and Partnerships. The yearlong effort included extensive reviews of government, public policy research groups, and academic studies, as well as interviews with a broad range of military and civilian officials in Washington, D.C., Pacific area commands and locally in California. Each working group developed a report and submitted it to the whole Committee and NPS for review. The report chapters share a common organization and include sections on background, method, observations, considerations, and recommendations. Across the working groups, Committee members identified several major trends that will require institutional change by the Defense and Navy Departments as well as NPS. Of greatest concern is increasing instability in the geostrategic landscape, growing complexity stemming from globalization, rapidly changing and proliferating technology, significant natural and financial resource constraints, and environmental challenges. All of these contribute to extreme levels of uncertainty in multiple dimensions, and are likely to change organizational planning assumptions as well as the cause and nature of future conflicts. The implications for defense and national security are the same as for NPS: large bureaucratic institutions will need to become more flexible and responsive to emerging requirements, while continuously working to improve the efficiency of their operations. Operating effectively in this emerging world will require institutions to engage people who are intellectually curious, tolerate ambiguity, embrace abstraction and lifelong learning, and are creative. Those skills will influence curricula development and organizational processes, as well as change the way the military, government, industry and academic institutions select their leaders. Future success must also acknowledge cultural changes that demand near-continuous access to information, and collaboration among internal and external entities. This change in the way people communicate necessitates a robust and secure cyber infrastructure that will be as fundamental to the NPS mission as buildings and classrooms. In addition to actions implied by these contextual trends, the working groups identified 45 specific recommendations in their areas of expertise, including many internal actions NPS can take immediately. Of greater importance are recommendations for more comprehensive change that may require additional study and liaison with external organizations. The following recommendations distill the most important themes of the Committee’s deliberations and imperatives for action that include an external reach with actions that require DoN engagement: 1. Implement a special charter status for NPS with the Department of the Navy that provides flexibility in hiring faculty and staff, funding and fund-raising, facilities, student markets, advertising/recruitment, and partnerships. 2. Capitalize on the need for innovation across capabilities, operational concepts, personnel policies and organizational structures. 3. Continue NPS’ responsiveness to national security priorities and accelerate development of hybrid resident/ distant programs to improve responsiveness to DoD/DoN and federal agency requirements. Investments in this area should consider the establishment of conference facilities. 4. Make the following visible and aggressive institutional priorities: classified research and education capabilities, energy, government acquisition, cyber, modeling and simulation, regional studies, and unmanned systems. Investments will have to include expansion of classified facilities. 5. Expand the NPS research portfolio and rebalance to increase 6.1/6.2 research. 6. Maintain technological flexibility with a robust cyberinfrastructure and services. 7. Consolidate base operations with local community and other local Department of Defense assets. 8. Work with SECNAV to modify promotion board precepts to value quality graduate education in the selection process. Request the CNO designate NPS and NWC as the major contributers to the Navy’s Graduate Education Strategy with objectives that place them at the core of providing graduate education for the Navy and other Services (and civilians). 9. Promote the NPS value proposition with DoD, DoN and federal agency leaders through programs, events, publications, and media. The overwhelming message in each of the chapters is flexibility. NPS requires flexibility for its future. • Enrollment Flexibility Include civilians and more international students to maximize existing capacity in selected programs • Curriculum Flexibility Expansion of hybrid programs that include resident and non-resident elements • Revenue Flexibility The ability to do fund-raising, accept and keep tuition and accept GI Bill support for veterans and spouses • Hiring Flexibility Ensure hiring the best faculty and staff talent to continue quality improvement in all areas of NPS • Technological Flexibility Maintain a robust cyberinfrastructure and services including the .edu capability • Facility Flexibility The ability to lease property, build and renovate facilities • Communication and Outreach Flexibility The ability to engage in recruiting and advertising and more expansive outreach to increase NPS visibility • Partnership Flexibility Make it easier for NPS to engage in strategic partnerships with other universities, laboratories, and industry • Organizational Flexibility Having the flexibility, where appropriate, to adapt to the most cost efficient and effective organization as significant changes occur in the world or the Department of Defense Like the Defense and Navy Departments it serves, NPS faces a future defined by complexity and uncertainty. Its mission and the tools it uses to educate students and conduct research are likely to change more rapidly than ever before, and its sponsors will be relentless in their search for operating efficiencies. These macro trends have implications for nearly every aspect of NPS operations. The next Strategic Plan will have to account for specific adjustments related to the above. More difficult perhaps will be the need to assess carefully some fundamental but difficult changes in organization and leadership selection, so that NPS has the agility and flexibility to meet 21st century challenges. The crucial element for the future is flexibility — not continued requests for additional resources or building on existing programs using the same historical patterns for program growth. The successful institutions of the future will be adaptable to changing conditions or newly discovered information. Speed of responsiveness will be another defining factor. Both require the flexibility to recruit and retain the best talent, expand and reduce physical capacity as needed, raise funds, reallocate resources, publicly communicate intentions and accomplishments, expand student markets, maintain technological currency and flexibility, increase international enrollments and engage in partnerships with other institutions and industry. NPS cannot rely solely on the unique nature of its operations to obtain the much-needed regulatory relief the Committee recommends. Rather, it will have to take persistent action to demonstrate the cost savings and related advantages of implementing them. However, there is cause for optimism because maintaining the status quo will not allow Defense and Navy Department leaders to achieve their objectives — they will have to seek alternative solutions. NPS possesses an abundance of talent among its faculty, staff and students — it has the proven capability not only to adapt to current trends, but also to become a leader among the Navy’s flagship institutions as it prepares for the next five years. The Naval Postgraduate School is a superb institution which provides a unique and valuable education to future leaders in the national security arena. It contributes significantly to scientific and scholarly inquiry that addresses the most difficult of national and international problems. NPS and the Navy have a responsibility to ensure NPS’ future vitality and contributions by taking the actions the committee has recommended.-- Executive SummaryCommittee on the Futur

We’re Here To Help! Faculty Resources [video]

FY12 Compass Seminar For New Facult