Effective inhomogeneous inflation: curvature inhomogeneities of the Einstein vacuum

We consider spatially averaged inhomogeneous universe models and argue that, already in the absence of sources, an effective scalar field arises through foliating and spatially averaging inhomogeneous geometrical curvature invariants of the Einstein vacuum. This scalar field (the `morphon') acts as an inflaton, if we prescribe a potential of some generic form. We show that, for any initially negative average spatial curvature, the morphon is driven through an inflationary phase and leads - on average - to a spatially flat, homogeneous and isotropic universe model, providing initial conditions for pre-heating and, by the same mechanism, a possibly natural self-exit.Comment: 9 pages, 2 figures, to appear in Class. Quant. Grav. as Fast Track Communicatio

Uniformly Accelerated Mirrors. Part 2: Quantum Correlations

We study the correlations between the particles emitted by a moving mirror. To this end, we first analyze $$, the two-point function of the stress tensor of the radiation field. In this we generalize the work undertaken by Carlitz and Willey. To further analyze how the vacuum correlations on $I^-$ are scattered by the mirror and redistributed among the produced pairs of particles, we use a more powerful approach based on the value of $T_{\mu\nu}$ which is conditional to the detection of a given particle on $I^+$. We apply both methods to the fluxes emitted by a uniformly accelerated mirror. This case is particularly interesting because of its strong interferences which lead to a vanishing flux, and because of its divergences which are due to the infinite blue shift effects associated with the horizons. Using the conditional value of $T_{\mu\nu}$, we reveal the existence of correlations between created particles and their partners in a domain where the mean fluxes and the two-point function vanish. This demonstrates that the scattering by an accelerated mirror leads to a steady conversion of vacuum fluctuations into pairs of quanta. Finally, we study the scattering by two uniformly accelerated mirrors which follow symmetrical trajectories (i.e. which possess the same horizons). When using the Davies-Fulling model, the Bogoliubov coefficients encoding pair creation vanish because of perfectly destructive interferences. When using regularized amplitudes, these interferences are inevitably lost thereby giving rise to pair creation.Comment: 30 pages, 9 postscript figure

Response of Unruh-DeWitt detector with time-dependent acceleration

It is well known that a detector, coupled linearly to a quantum field and accelerating through the inertial vacuum with a constant acceleration $g$, will behave as though it is immersed in a radiation field with temperature $T=(g/2\pi)$. We study a generalization of this result for detectors moving with a time-dependent acceleration $g(\tau)$ along a given direction. After defining the rate of excitation of the detector appropriately, we evaluate this rate for time-dependent acceleration, $g(\tau)$, to linear order in the parameter $\eta = \dot g / g^2$. In this case, we have three length scales in the problem: $g^{-1}, (\dot g/g)^{-1}$ and $\omega^{-1}$ where $\omega$ is the energy difference between the two levels of the detector at which the spectrum is probed. We show that: (a) When $\omega^{-1} \ll g^{-1} \ll (\dot g/g)^{-1}$, the rate of transition of the detector corresponds to a slowly varying temperature $T(\tau) = g(\tau)/2 \pi$, as one would have expected. (b) However, when $g^{-1}\ll \omega^{-1} \ll (\dot g/g)^{-1}$, we find that the spectrum is modified \textit{even at the order $\mathcal{O}(\eta)$}. This is counter-intuitive because, in this case, the relevant frequency does not probe the rate of change of the acceleration since $(\dot g/g) \ll \omega$ and we certainly do not have deviation from the thermal spectrum when $\dot g =0$. This result shows that there is a subtle discontinuity in the behaviour of detectors with $\dot g = 0$ and $\dot g/g^2$ being arbitrarily small. We corroborate this result by evaluating the detector response for a particular trajectory which admits an analytic expression for the poles of the Wightman function.Comment: v1, 7 pages, no figures; v2, an Acknowledgment and some clarifying comments added, matches version accepted for publication in Physics Letters

Global gravitational instability of FLRW backgrounds - interpreting the dark sectors

The standard model of cosmology is based on homogeneous-isotropic solutions of Einstein's equations. These solutions are known to be gravitationally unstable to local inhomogeneous perturbations, commonly described as evolving on a background given by the same solutions. In this picture, the FLRW backgrounds are taken to describe the average over inhomogeneous perturbations for all times. We study in the present article the (in)stability of FLRW dust backgrounds within a class of averaged inhomogeneous cosmologies. We examine the phase portraits of the latter, discuss their fixed points and orbital structure and provide detailed illustrations. We show that FLRW cosmologies are unstable in some relevant cases: averaged models are driven away from them through structure formation and accelerated expansion. We find support for the proposal that the dark components of the FLRW framework may be associated to these instability sectors. Our conclusion is that FLRW cosmologies have to be considered critically as for their role to serve as reliable models for the physical background.Comment: 15 pages, 13 figures, 1 table. Matches published version in CQ

Accelerating towards P. vivax elimination with a novel serological test-and-treat strategy: a modelling case study in Brazil

BACKGROUND: Plasmodium vivax malaria is challenging to control and eliminate. Treatment with radical cure drugs fails to target the hidden asymptomatic and hypnozoite reservoirs in populations. PvSeroTAT, a novel serological test-and-treat intervention using a serological diagnostic to screen hypnozoite carriers for radical cure eligibility and treatment, could accelerate P. vivax elimination. METHODS: Using a previously developed mathematical model of P. vivax transmission adapted to the Brazilian context as a case study for implementation, we evaluate the public health impact of various deployment strategies of PvSeroTAT as a mass campaign. We compare relative reductions in prevalence, cases averted, glucose-6-phosphate dehydrogenase (G6PD) tests, and treatment doses of PvSeroTAT campaigns to strengthened case management alone or mass drug administration (MDA) campaigns across different settings. FINDINGS: Deploying a single round of PvSeroTAT with 80% coverage to treat cases with a high efficacy radical cure regimen with primaquine is predicted to reduce point population prevalence by 22.5% [95% UI: 20.2%-24.8%] in a peri-urban setting with high transmission and by 25.2% [95% UI: 9.6%-42.2%] in an occupational setting with moderate transmission. In the latter example, while a single PvSeroTAT achieves 9.2% less impact on prevalence and averts 300 less cases per 100,000 than a single MDA (25.2% [95% UI: 9.6%-42.2%] point prevalence reduction versus 34.4% [95% UI: 24.9%-44%]), PvSeroTAT requires 4.6 times less radical cure treatments and G6PD tests. Layering strengthened case management and deploying four rounds of PvSeroTAT six months apart is predicted to reduce point prevalence by a mean of 74.1% [95% UI: 61.3%-86.3%] or more in low transmission settings with less than 10 cases per 1000 population. INTERPRETATION: Modelling predicts that mass campaigns with PvSeroTAT are predicted to reduce P. vivax parasite prevalence across a range of transmission settings and require fewer resources than MDA. In combination with strengthened case management, mass campaigns of serological test-and-treat interventions can accelerate towards P. vivax elimination. FUNDING: This project was funded in part by the Bill and Melinda Gates Foundation and the National Health and Medical Research Council

Developing sero-diagnostic tests to facilitate Plasmodium vivax Serological Test-and-Treat approaches: modeling the balance between public health impact and overtreatment.

BACKGROUND: Eliminating Plasmodium vivax will require targeting the hidden liver-stage reservoir of hypnozoites. This necessitates new interventions balancing the benefit of reducing vivax transmission against the risk of over-treating some individuals with drugs which may induce haemolysis. By measuring antibodies to a panel of vivax antigens, a strategy of serological-testing-and-treatment (PvSeroTAT) can identify individuals with recent blood-stage infections who are likely to carry hypnozoites and target them for radical cure. This provides a potential solution to selectively treat the vivax reservoir with 8-aminoquinolines. METHODS: PvSeroTAT can identify likely hypnozoite carriers with ~80% sensitivity and specificity. Diagnostic test sensitivities and specificities ranging 50-100% were incorporated into a mathematical model of vivax transmission to explore how they affect the risks and benefits of different PvSeroTAT strategies involving hypnozoiticidal regimens. Risk was measured as the rate of overtreatment and benefit as reduction of community-level vivax transmission. RESULTS: Across a wide range of combinations of diagnostic sensitivity and specificity, PvSeroTAT was substantially more effective than bloodstage mass screen and treat strategies and only marginally less effective than mass drug administration. The key test characteristic determining of the benefit of PvSeroTAT strategies is diagnostic sensitivity, with higher values leading to more hypnozoite carriers effectively treated and greater reductions in vivax transmission. The key determinant of risk is diagnostic specificity: higher specificity ensures that a lower proportion of uninfected individuals are unnecessarily treated with primaquine. These relationships are maintained in both moderate and low transmission settings (qPCR prevalence 10% and 2%). Increased treatment efficacy and adherence can partially compensate for lower test performance. Multiple rounds of PvSeroTAT with a lower performing test may lead to similar or higher reductions in vivax transmission than fewer rounds with a higher performing test, albeit with higher rate of overtreatment. CONCLUSIONS: At current performance, PvSeroTAT is predicted to be a safe and efficacious option for targeting the hypnozoite reservoir towards vivax elimination. P. vivax sero-diagnostic tests should aim for both high performance and ease of use in the field. The target product profiles informing such development should thus reflect the trade-offs between impact, overtreatment, and ease of programmatic implementation

Differential impact of malaria control interventions on P. falciparum and P. vivax infections in young Papua New Guinean children

INTRODUCTION: As malaria transmission declines, understanding the differential impact of intensified control on Plasmodium falciparum relative to Plasmodium vivax and identifying key drivers of ongoing transmission is essential to guide future interventions. METHODS: Three longitudinal child cohorts were conducted in Papua New Guinea before (2006/2007), during (2008) and after scale-up of control interventions (2013). In each cohort, children aged 1-5 years were actively monitored for infection and illness. Incidence of malaria episodes, molecular force of blood-stage infections (molFOB) and population-averaged prevalence of infections were compared across the cohorts to investigate the impact of intensified control in young children and the key risk factors for malaria infection and illness in 2013. RESULTS: Between 2006 and 2008, P. falciparum infection prevalence, molFOB, and clinical malaria episodes reduced by 47%, 59% and 69%, respectively, and a further 49%, 29% and 75% from 2008 to 2013 (prevalence 41.6% to 22.1% to 11.2%; molFOB: 3.4 to 1.4 to 1.0 clones/child/year; clinical episodes incidence rate (IR) 2.6 to 0.8 to IR 0.2 episodes/child/year). P. vivax clinical episodes declined at rates comparable to P. falciparum between 2006, 2008 and 2013 (IR 2.5 to 1.1 to 0.2), while P. vivax molFOB (2006, 9.8; 2008, 12.1) and prevalence (2006, 59.6%; 2008, 65.0%) remained high in 2008. However, in 2013, P. vivax molFOB (1.2) and prevalence (19.7%) had also substantially declined. In 2013, 89% of P. falciparum and 93% of P. vivax infections were asymptomatic, 62% and 47%, respectively, were sub-microscopic. Area of residence was the major determinant of malaria infection and illness. CONCLUSION: Intensified vector control and routine case management had a differential impact on rates of P. falciparum and P. vivax infections but not clinical malaria episodes in young children. This suggests comparable reductions in new mosquito-derived infections but a delayed impact on P. vivax relapsing infections due to a previously acquired reservoir of hypnozoites. This demonstrates the need to strengthen implementation of P. vivax radical cure to maximise impact of control in co-endemic areas. The high heterogeneity of malaria in 2013 highlights the importance of surveillance and targeted interventions to accelerate towards elimination

Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis

International audienceObjectives:Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE.Methods: From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation.Results Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality.Conclusions The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results

Zika vector competence data reveals risks of outbreaks: the contribution of the European ZIKAlliance project

First identified in 1947, Zika virus took roughly 70 years to cause a pandemic unusually associated with virus-induced brain damage in newborns. Zika virus is transmitted by mosquitoes, mainly Aedes aegypti, and secondarily, Aedes albopictus, both colonizing a large strip encompassing tropical and temperate regions. As part of the international project ZIKAlliance initiated in 2016, 50 mosquito populations from six species collected in 12 countries were experimentally infected with different Zika viruses. Here, we show that Ae. aegypti is mainly responsible for Zika virus transmission having the highest susceptibility to viral infections. Other species play a secondary role in transmission while Culex mosquitoes are largely non-susceptible. Zika strain is expected to significantly modulate transmission efficiency with African strains being more likely to cause an outbreak. As the distribution of Ae. aegypti will doubtless expand with climate change and without new marketed vaccines, all the ingredients are in place to relive a new pandemic of Zika.info:eu-repo/semantics/publishedVersio

A Qualitative Analysis of Experiential Challenges Associated with Meditation Practice

Although empirical interest in meditation has flourished in recent years, few studies have addressed possible downsides of meditation practice, particularly in community populations. In-depth interviews were conducted with 30 male meditators in London, UK, recruited using principles of maximum variation sampling, and analysed using a modified constant comparison approach. Having originally set out simply to inquire about the impact of various meditation practices (including but not limited to mindfulness) on men’s wellbeing, we uncovered psychological challenges associated with its practice. While meditation was generally reported to be conducive to wellbeing, substantial difficulties accounted for approximately one quarter of the interview data. Our paper focuses specifically on these issues in order to alert health professionals to potential challenges associated with meditation. Four main problems of increasing severity were uncovered: Meditation was a difficult skill to learn and practise; participants encountered troubling thoughts and feelings which were hard to manage; meditation reportedly exacerbated mental health issues, such as depression and anxiety; and in a few cases, meditation was associated with psychotic episodes. Our paper raises important issues around safeguarding those who practise meditation, both within therapeutic settings and in the community