Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa.

Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC) CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs) were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3%) of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness

Evolutionary history and identification of conservation units in the giant otter, Pteronura brasiliensis.

The giant otter, Pteronura brasiliensis, occupies a range including the major drainage basins of South America, yet the degree of structure that exists within and among populations inhabiting these drainages is unknown. We sequenced portions of the mitochondrial DNA (mtDNA) cytochrome b (612 bp) and control region (383 bp) genes in order to determine patterns of genetic variation within the species. We found high levels of mtDNA haplotype diversity (h = 0.93 overall) and support for subdivision into four distinct groups of populations, representing important centers of genetic diversity and useful units for prioritizing conservation within the giant otter. We tested these results against the predictions of three hypotheses of Amazonian diversification (Pleistocene Refugia, Paleogeography, and Hydrogeology). While the phylogeographic pattern conformed to the predictions of the Refugia Hypothesis, molecular dating using a relaxed clock revealed the phylogroups diverged from one another between 1.69 and 0.84 Ma, ruling out the influence of Late Pleistocene glacial refugia. However, the role of Plio-Pleistocene climate change could not be rejected. While the molecular dating also makes the influence of geological arches according to the Paleogeography Hypothesis extremely unlikely, the recent Pliocene formation of the Fitzcarrald Arch and its effect of subsequently altering drainage pattern could not be rejected. The data presented here support the interactions of both climatic and hydrological changes resulting from geological activity in the Plio-Pleistocene, in shaping the phylogeographic structure of the giant otter

Spatial modeling of individual-level infectious disease transmission: Tuberculosis data in Manitoba, Canada

Geographically dependent individual level models (GD-ILMs) are a class of statistical models that can be used to study the spread of infectious disease through a population in discrete-time in which covariates can be measured both at individual and area levels. The typical ILMs to illustrate spatial data are based on the distance between susceptible and infectious individuals. A key feature of GD-ILMs is that they take into account the spatial location of the individuals in addition to the distance between susceptible and infectious individuals. As a motivation of this article, we consider tuberculosis (TB) data which is an infectious disease which can be transmitted through individuals. It is also known that certain areas/demographics/communities have higher prevalent of TB (see Section 4 for more details). It is also of interest of policy makers to identify those areas with higher infectivity rate of TB for possible preventions. Therefore, we need to analyze this data properly to address those concerns. In this article, the expectation conditional maximization algorithm is proposed for estimating the parameters of GD-ILMs to be able to predict the areas with the highest average infectivity rates of TB. We also evaluate the performance of our proposed approach through some simulations. Our simulation results indicate that the proposed method provides reliable estimates of parameters which confirms accuracy of the infectivity rates

Magnetic properties of REE fluorcarbonate minerals and their implications for minerals processing

This is the final version. Available on open access from Elsevier via the DOI in this recordRare earth elements (REE) are considered as critical metals for electronics and green technology. The REE fluorcarbonates are one of the main REE ore minerals, common in many different types of REE deposit and yet some of their fundamental properties have still not been determined. This study measured the magnetic properties of pure REE fluorcarbonate single crystal minerals using a vibrating sample magnetometer (VSM) and determined their elemental compositions using electron probe microanalysis (EPMA). The results provide the first measurements of the magnetic behaviour and susceptibility of REE fluorcarbonates other than bastnäsite-(Ce). The magnetic susceptibility of REE fluorcarbonates varies systematically from one mineral to another and is highly dependent on the mineral chemistry. It is positive (paramagnetic) for bastnäsite-(Ce) and gradually decreases as the amount of Ca increases in parisite-(Ce), becoming negative (diamagnetic) for the Ca-rich member of the series, röntgenite. Synchysite-(Ce) is difficult to measure, generate good signal and acquire accurate readings because it practically always occurs as <5 mg crystals. Its magnetic susceptibility in samples from a REE ore deposit was experimentally determined by magnetic separation and checked by an associated study using a SQUID magnetometer, synchysite-(Ce) behaved as a diamagnetic mineral. This can be explained by the increase of Ca content and decrease of REE content, in addition to the variations in the layered structure common to the REE fluorcarbonate series minerals. Given the wide range of magnetic susceptibility of REE fluorcarbonates, it is important that the mineralogy is determined carefully before setting up a mineral processing flow sheet.Mkango Resources LtdNatural Environment Research Council (NERC

On the secondary star of the cataclysmic variable 1RXS J094432.1+035738

We present V and Rc band photometry and optical near-infrared spectroscopy of the cataclysmic variable 1RXS J094432.1+035738. We detected features of a cool secondary star, which can be modeled with a red dwarf of spectral type M2 (+0.5 -1.0) V at a distance of 433 +- 100 pc.Comment: Accepted for publication in Astronomy and Astrophysic

All-Sky spectrally matched UBVRI-ZY and u'g'r'i'z' magnitudes for stars in the Tycho2 catalog

We present fitted UBVRI-ZY and u'g'r'i'z' magnitudes, spectral types and distances for 2.4M stars, derived from synthetic photometry of a library spectrum that best matches the Tycho2 BtVt, NOMAD Rn and 2MASS JHK_{2/S} catalog magnitudes. We present similarly synthesized multi-filter magnitudes, types and distances for 4.8M stars with 2MASS and SDSS photometry to g<16 within the Sloan survey region, for Landolt and Sloan primary standards, and for Sloan Northern (PT) and Southern secondary standards. The synthetic magnitude zeropoints for BtVt, UBVRI, ZvYv, JHK_{2/S}, JHK_{MKO}, Stromgren uvby, Sloan u'g'r'i'z' and ugriz are calibrated on 20 calspec spectrophotometric standards. The UBVRI and ugriz zeropoints have dispersions of 1--3%, for standards covering a range of color from -0.3 < V-I < 4.6; those for other filters are in the range 2--5%. The spectrally matched fits to Tycho2 stars provide estimated 1-sigma errors per star of ~0.2, 0.15, 0.12, 0.10 and 0.08 mags respectively in either UBVRI or u'g'r'i'z'; those for at least 70% of the SDSS survey region to g<16 have estimated 1-sigma errors per star of ~0.2, 0.06, 0.04, 0.04, 0.05 in u'g'r'i'z' or UBVRI. The density of Tycho2 stars, averaging about 60 stars per square degree, provides sufficient stars to enable automatic flux calibrations for most digital images with fields of view of 0.5 degree or more. Using several such standards per field, automatic flux calibration can be achieved to a few percent in any filter, at any airmass, in most workable observing conditions, to facilitate inter-comparison of data from different sites, telescopes and instruments.Comment: 36 pages, 30 figures, 3 printed tables, several electronic tables, accepted PASP Dec 201

The strong coupling constant from lattice QCD with N_f=2 dynamical quarks

We compute $\Lambda_{\bar{MS}}$ for two flavors of light dynamical quarks using non-perturbatively $O(a)$ improved Wilson fermions. We improve on a recent calculation by employing Pad\'e-improved two-loop and three-loop perturbation theory to convert the lattice numbers to the $\bar{MS}$ scheme.Comment: Contribution to Lattice 2001 (matrix elements), typo correcte

Fermion zero modes in N=2 supervortices

We study the fermionic zero modes of BPS semilocal magnetic vortices in N=2 supersymmetric QED with a Fayet-Iliopoulos term and two matter hypermultiplets of opposite charge. There is a one-parameter family of vortices with arbitrarily wide magnetic cores. Contrary to the situation in pure Nielsen-Olesen vortices, new zero modes are found which get their masses from Yukawa couplings to scalar fields that do not wind and are non-zero at the core. We clarify the relation between fermion mass and zero modes. The new zero modes have opposite chiralities and therefore do not affect the net counting (left minus right) of zero modes coming from index theorems but manage to evade other index theorems in the literature that count the total number (left plus right) of zero modes in simpler systems.Comment: 9 pages, 1 figure. Uses Revtex4. Revised version includes discussion about the back-reaction of the fermions on the background vortex. Version to be published in Phys. Rev.