Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades

Background In 2014, the Joint United Nations Programme on HIV and AIDS (UNAIDS) and partners set the ‘90-90-90 targets’; aiming to diagnose 90% of all HIV positive people, provide antiretroviral therapy (ART) for 90% of those diagnosed and achieve viral suppression for 90% of those treated, by 2020. This results in 81% of all HIV positive people on treatment and 73% of all HIV positive people achieving viral suppression. We aimed to analyse how effective national HIV treatment programmes are at meeting these targets, using HIV care continuums or cascades. Methods We searched for HIV treatment cascades for 196 countries in published papers, conference presentations, UNAIDS databases and national reports. Cascades were constructed using reliable, generalisable, recent data from national, cross-sectional and longitudinal study cohorts. Data were collected for four stages; total HIV positive people, diagnosed, on treatment and virally suppressed. The cascades were categorised as complete (four stages) or partial (3 stages), and analysed for ‘break points’ defined as a drop >10% in coverage between consecutive 90-90-90 targets. Results 69 country cascades were analysed (32 complete, 37 partial). Diagnosis (target one—90%) ranged from 87% (the Netherlands) to 11% (Yemen). Treatment coverage (target two—81% on ART) ranged from 71% (Switzerland) to 3% (Afghanistan). Viral suppression (target three—73% virally suppressed) was between 68% (Switzerland) and 7% (China). Conclusions No country analysed met the 90-90-90 targets. Diagnosis was the greatest break point globally, but the most frequent key break point for individual countries was providing ART to those diagnosed. Large disparities were identified between countries. Without commitment to standardised reporting methodologies, international comparisons are complex

Simulating Radiative Magnetohydrodynamical Flows with AstroBEAR: Implementation and Applications of Non-equilibrium Cooling

Radiative cooling plays a crucial role in the dynamics of many astrophysical flows, and is particularly important in the dense shocked gas within Herbig-Haro (HH) objects and stellar jets. Simulating cooling processes accurately is necessary to compare numerical simulations with existing and planned observations of HH objects, such as those from the Hubble Space Telescope and the James Webb Space Telescope. In this paper we discuss a new, non-equilibrium cooling scheme we have implemented into the 3-D magnetohydrodynamic (MHD) code AstroBEAR. The new cooling function includes ionization, recombination, and excitation of all the important atomic species that cool below 10000 K. We tested the routine by comparing its predictions with those from the well-tested 1-D Cox-Raymond shock code (Raymond 1979). The results show thatAstroBEAR accurately tracks the ionization fraction, temperature, and other MHD variables for all low-velocity (.90 km/s) magnetized radiative shock waves. The new routine allows us to predict synthetic emission maps in all the bright forbidden and permitted lines observed in stellar jets, including H{\alpha}, [NII], [OI], and [SII]. We present an example as to how these synthetic maps facilitate a direct comparison with narrowband images of HH objects.Comment: 8 figure

Identifying safety strategies for on-farm grain bins using risk analysis

The potential for grain bin accidents exists each year on Arkansas farms and farms across the nation. The trend toward increasing utilization of on-farm grain drying and storage could lead to an increase in grain bin accidents. The sharp contrast between a safe, efficient operation and one that leads to injury or death can be represented as sets of farmer-decisions and subsequent chance events. A model was constructed to define the risk associated with grain bin entry and inbin activity so that safety interventions could be identified and implemented to reduce the probability of injury and death. A survey was distributed to Arkansas grain farmers to gather data on the level of safety education, storage techniques, operations management, and other parameters. The data collected from the survey provided quantitative input of many of the model’s probability-distribution functions. Using a fault tree (with parallel modes of failure) in conjunction with a Monte Carlo simulation technique, we evaluated six safety intervention strategies and identified the one with the greatest potential for reducing the risk of serous injury or death. As part of senior design in biological engineering, plans are underway to design and test a probe that can locate and break bridged grain (a common risk factor in grain bin management) while working outside the bin on the ground

New targets for resolution of airway remodeling in obstructive lung diseases.

Airway remodeling (AR) is a progressive pathological feature of the obstructive lung diseases, including asthma and chronic obstructive pulmonary disease (COPD). The pathology manifests itself in the form of significant, progressive, and (to date) seemingly irreversible changes to distinct respiratory structural compartments. Consequently, AR correlates with disease severity and the gradual decline in pulmonary function associated with asthma and COPD. Although current asthma/COPD drugs manage airway contraction and inflammation, none of these effectively prevent or reverse features of AR. In this review, we provide a brief overview of the features and putative mechanisms affecting AR. We further discuss recently proposed strategies with promise for deterring or treating AR

Pressure dependence of the spin dynamics around a quantum critical point : An inelastic neutron scattering study of Ce0.87La0.13Ru2Si2

Inelastic neutron scattering experiments performed on a single crystal of the antiferromagnetic compound Ce$_{0.87}$La$_{0.13}$Ru$_{2}$Si$_{2}$ under applied pressures of up to 5 kbar are reported. A quantum critical point is reached at around 2.6 kbar where long-range magnetic order disappears. The variation of the characteristic energy scales with respect to temperature and pressure is followed and found to saturate in the ordered phase.Comment: 14 pages (6 figures

Building the Terrestrial Planets: Constrained Accretion in the Inner Solar System

To date, no accretion model has succeeded in reproducing all observed constraints in the inner Solar System. These constraints include 1) the orbits, in particular the small eccentricities, and 2) the masses of the terrestrial planets -- Mars' relatively small mass in particular has not been adequately reproduced in previous simulations; 3) the formation timescales of Earth and Mars, as interpreted from Hf/W isotopes; 4) the bulk structure of the asteroid belt, in particular the lack of an imprint of planetary embryo-sized objects; and 5) Earth's relatively large water content, assuming that it was delivered in the form of water-rich primitive asteroidal material. Here we present results of 40 high-resolution (N=1000-2000) dynamical simulations of late-stage planetary accretion with the goal of reproducing these constraints, although neglecting the planet Mercury. We assume that Jupiter and Saturn are fully-formed at the start of each simulation, and test orbital configurations that are both consistent with and contrary to the "Nice model." We find that a configuration with Jupiter and Saturn on circular orbits forms low-eccentricity terrestrial planets and a water-rich Earth on the correct timescale, but Mars' mass is too large by a factor of 5-10 and embryos are often stranded in the asteroid belt. A configuration with Jupiter and Saturn in their current locations but with slightly higher initial eccentricities (e = 0.07-0.1) produces a small Mars, an embryo-free asteroid belt, and a reasonable Earth analog but rarely allows water delivery to Earth. None of the configurations we tested reproduced all the observed constraints. (abridged)Comment: Accepted to Icarus. 21 pages, 12 figures, 5 tables in emulateapj format. Figures 3 and 4 degraded. For full-resolution see http://casa.colorado.edu/~raymonsn/ms_emulateapj.pd

Circle actions, central extensions and string structures

The caloron correspondence can be understood as an equivalence of categories between $G$-bundles over circle bundles and $LG \rtimes_\rho S^1$-bundles where $LG$ is the group of smooth loops in $G$. We use it, and lifting bundle gerbes, to derive an explicit differential form based formula for the (real) string class of an $LG \rtimes_\rho S^1$-bundle.Comment: 25 page

Low energy magnetic excitation spectrum of the unconventional ferromagnet CeRh3_{3}B2_{2}

The magnetic excitation spectrum of the unconventional ferromagnet CeRh$_{3}$B$_{2}$ was measured by inelastic neutron scattering on single crystal sample in the magnetically ordered and paramagnetic phases. The spin-wave excitation spectrum evidences high exchange interaction along the c-axis about two orders of magnitude higher than the ones in the basal plane of the hexagonal structure. Both strong out of plane and small in plane anisotropies are found. This latter point confirms that considering the $J$=5/2 multiplet alone is not adequate for describing the ground state of CeRh$_{3}$B$_{2}$. Quasielastic scattering measured above $T_{Curie}$ is also strongly anisotropic between the basal plane and the c-axis and suggests localized magnetism.Comment: 8 Figure

Next-to-Leading Order Corrections to Single Top Quark Production and Decay at the Tevatron: 2. tt-channel Process

We present a study of the $t$-channel mode of single top quark production at the upgraded Tevatron $p\bar{p}$ collider, including the next-to-leading order (NLO) QCD corrections to the production and the decay of a single top quark. The narrow width approximation was adopted in order to preserve the spin of the top quark in its production and decay. We discuss the effects of different $O(\alpha_s)$ contributions on the inclusive cross section as well as various kinematic distributions after imposing the relevant cuts to select $t$-channel single top signal events.Comment: 46 pages, 47 figures. One typo in LaTeX source file is correcte

Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry:A Cross-sectional Study of Common Conditions in the United States

BACKGROUND: Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties. METHODS AND FINDINGS: We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies. Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating “pre-disease”; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes. Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications. CONCLUSIONS: For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies. Please see later in the article for the Editors' Summar