Program Annual Technology Report: Physics of the Cosmos Program Office

From ancient times, humans have looked up at the night sky and wondered: Are we alone? How did the universe come to be? How does the universe work? PCOS focuses on that last question. Scientists investigating this broad theme use the universe as their laboratory, investigating its fundamental laws and properties. They test Einsteins General Theory of Relativity to see if our current understanding of space-time is borne out by observations. They examine the behavior of the most extreme environments supermassive black holes, active galactic nuclei, and others and the farthest reaches of the universe, to expand our understanding. With instruments sensitive across the spectrum, from radio, through infrared (IR), visible light, ultraviolet (UV), to X rays and gamma rays, as well as gravitational waves (GWs), they peer across billions of light-years, observing echoes of events that occurred instants after the Big Bang. Last year, the LISA Pathfinder (LPF) mission exceeded expectations in proving the maturity of technologies needed for the Laser Interferometer Space Antenna (LISA) mission, and the Laser Interferometer Gravitational-Wave Observatory (LIGO) recorded the first direct measurements of long-theorized GWs. Another surprising recent discovery is that the universe is expanding at an ever-accelerating rate, the first hint of so-called dark energy, estimated to account for 75% of mass-energy in the universe. Dark matter, so called because we can only observe its effects on regular matter, is thought to account for another20%, leaving only 5% for regular matter and energy. Scientists now also search for special polarization in the cosmic microwave background to support the notion that in the split-second after the Big Bang, the universe inflated faster than the speed of light! The most exciting aspect of this grand enterprise today is the extraordinary rate at which we can harness technologies to enable these key discoveries

Cosmic Origins Program Annual Technology Report

What is the Cosmic Origins (COR) Program? From ancient times, humans have looked up at the night sky and wondered: Are we alone? How did the universe come to be? How does the universe work? COR focuses on the second question. Scientists investigating this broad theme seek to understand the origin and evolution of the universe from the Big Bang to the present day, determining how the expanding universe grew into a grand cosmic web of dark matter enmeshed with galaxies and pristine gas, forming, merging, and evolving over time. COR also seeks to understand how stars and planets form from clouds in these galaxies to create the heavy elements that are essential to life starting with the first generation of stars to seed the universe, and continuing through the birth and eventual death of all subsequent generations of stars. The COR Programs purview includes the majority of the field known as astronomy, from antiquity to the present

Program Technology Gaps A Presentation to the Mirror Tech 2015 Workshop

This talk will discuss the span of highest priority technologies for both astrophysics programs: what the top technology need categories are; competed lines available; what we are already funding

Prevalence of cryptococcal antigenemia and cost-effectiveness of a cryptococcal antigen screening program--Vietnam.

An estimated 120,000 HIV-associated cryptococcal meningitis (CM) cases occur each year in South and Southeast Asia; early treatment may improve outcomes. The World Health Organization (WHO) recently recommended screening HIV-infected adults with CD4<100 cells/mm(3) for serum cryptococcal antigen (CrAg), a marker of early cryptococcal infection, in areas of high CrAg prevalence. We evaluated CrAg prevalence and cost-effectiveness of this screening strategy in HIV-infected adults in northern and southern Vietnam.Serum samples were collected and stored during 2009-2012 in Hanoi and Ho Chi Minh City, Vietnam, from HIV-infected, ART-naïve patients presenting to care in 12 clinics. All specimens from patients with CD4<100 cells/mm(3) were tested using the CrAg lateral flow assay. We obtained cost estimates from laboratory staff, clinicians and hospital administrators in Vietnam, and evaluated cost-effectiveness using WHO guidelines.Sera from 226 patients [104 (46%) from North Vietnam and 122 (54%) from the South] with CD4<100 cells/mm(3) were available for CrAg testing. Median CD4 count was 40 (range 0-99) cells/mm(3). Nine (4%; 95% CI 2-7%) specimens were CrAg-positive. CrAg prevalence was higher in South Vietnam (6%; 95% CI 3-11%) than in North Vietnam (2%; 95% CI 0-6%) (p = 0.18). Cost per life-year gained under a screening scenario was $190,$137, and $119 at CrAg prevalences of 2%, 4% and 6%, respectively.CrAg prevalence was higher in southern compared with northern Vietnam; however, CrAg screening would be considered cost-effective by WHO criteria in both regions. Public health officials in Vietnam should consider adding cryptococcal screening to existing national guidelines for HIV/AIDS care

Costs associated with cryptococcal meningitis diagnosis, treatment and a cryptococcal screening program in Vietnam, in US dollars.

*<p>Inclusive of: CSF culture, cell count, glucose, protein, India Ink, and LFA.</p

Sensitivity analysis: variation in cost/LYG through screening by varied testing and drug costs, positive symptoms screen, LP rate, CM mortality rate and discount rate.

<p>Sensitivity analysis: variation in cost/LYG through screening by varied testing and drug costs, positive symptoms screen, LP rate, CM mortality rate and discount rate.</p

Cost-effectiveness of cryptococcal screening at a range of prevalences and cost scenarios.

<p>This graph has prevalence of asymptomatic cryptococcal antigenemia on the x-axis and incremental cost-effectiveness ratio (ICER) (increased cost per life-year gained [LYG] in US dollars) on the y-axis. The blue line represents the cost curve of full-cost fluconazole for one year of treatment. The red line represents the cost curve of full-cost fluconazole for ten weeks of treatment; the green line represents the cost curve of if fluconazole is obtained at no-cost. For Vietnam, the World Health Organization considers any intervention with an ICER under $6,948 to be ‘highly cost-effective’. This graph shows that cryptococcal screening, at any prevalence and under each of the three cost scenarios, should be considered a highly cost-effective intervention in Vietnam.</p

Number Needed to Screen (NNS), by prevalence of serum CrAg-positive persons in Vietnam.

<p>Number Needed to Screen (NNS), by prevalence of serum CrAg-positive persons in Vietnam.</p

Assumptions of a cost-effectiveness model for cryptococcal screening in Vietnam.

*<p>Dr. Cao Thuy, physician.</p>**<p>Assumed to be slightly lower than mortality among CM patients under existing standard of care, due to earlier diagnosis and treatment.</p>***<p>Assumed to be slightly higher than mortality among serum CrAg-negative patients under a screening scenario.</p

CrAg-positive prevalence by CD4 count and region of Vietnam.

<p>CrAg-positive prevalence by CD4 count and region of Vietnam.</p