Comparison of two tracer gas dilution methods for the determination of clothing ventilation and of vapour resistance

Clothing microclimate ventilation is an important parameter in climatic stress and in contaminated environments. The two main methods for its determination (Crockford et al. (CR) 1972 and Lotens and Havenith (LH) 1988) were, after further development, compared in terms of reproducibility, validity and usability. Both methods were shown to have a good sensitivity and reproducibility (with average coefficients of variation 1.5-2.3% for the method alone and up to 7% for method and clothing/movement effects combined). They produced values very close to calibration values in forced ventilation tests (r = 0.988). Weak points for the CR method were the limits in the time constant of the measurement apparatus, causing an upper limit to the ventilation that can be reliably measured (around 800 l/min) and the method of measuring clothing microclimate volume. The original 'vacuum oversuit' (CR) method was cumbersome and prone to large errors. Alternative methods of measuring clothing microclimate volume (whole body scanner or manual circumference measurements) were shown to produce good results. For the LH method, the distribution of the tracer gas over the whole skin surface became a problem factor at very high ventilations (above 1000 l/min). As all methods use tracer gases (O2, Ar, CO2, SF6) with diffusivities smaller than that of water vapour, this potentially creates a problem in the calculation of vapour resistance from the ventilation values in the region where the emphasis of vapour transfer moves from diffusion to convection. In most real-life situations, where body and air movement are present, a correction is not however required because the error remains below 10%. Statement of Relevance: Clothing ventilation indicates heat loss potential as well as risk of pollutants entering the clothing. Two main methods for its determination are compared and validated, identifying a number of issues. An in-depth analysis is given of the advantages and disadvantages of the available methodologies. © 2010 Taylor & Francis

Effects of zirconium element on the microstructure and deuterium retention of W–Zr/Sc2O3 composites

Dense W and W–Zr composites reinforced with Sc(2)O(3) particles were produced through powder metallurgy and subsequent spark plasma sintering (SPS) at 1700 °C and 58 MPa. Results showed that the W–1vol.%Zr/2vol.%Sc(2)O(3) composites exhibited optimal performance with the best relative density of up to 98.93% and high Vickers microhardness of approximately 583 Hv. The thermal conductivity of W–Zr/Sc(2)O(3) composites decreased initially and then increased as the Zr content increased. The moderate Zr alloying element could combine well with Sc(2)O(3) particles and W grains and form a solid solution. However, excess Zr element leads to agglomeration in the grain boundaries. W–1vol.%Zr/2vol.%Sc(2)O(3) composite had a good deuterium irradiation resistance very closing to pure tungsten compared with the other Zr element contents of composites. Under 500 K, D(2) retention and release of them were similar to those of commercial tungsten, even lower between 400 K to 450 K. Pre-irradiation with 5 keV-He(+) ions to a fluence of 1 × 10(21) He(+)/m(2) resulted in an increase in deuterium retention (deuterium was implanted after He(+) irradiation), thereby shifting the desorption peak to a high temperature from 550 K to 650 K for the W–1vol.%Zr/2vol.%Sc(2)O(3) composite

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated