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Adherence to antiretroviral therapy (ART) remains sub-optimal among pregnant and postpartum women with HIV (PPWH) in high HIV prevalence low resource settings with few effective behavioral interventions. A large body of qualitative literature has established general barriers and facilitators to ART adherence in PPWH at various levels (individual, interpersonal, structural). However, research exploring the underlying behavioral mechanisms of ART adherence in PPWH with objectively verified adherence biomarkers is extremely limited. We conducted 24 in-depth interviews with postpartum women in western Kenya who had linked ART drug concentrations obtained from three dried blood spot samples across the peripartum period. Among PPWH with a low drug concentration (n = 13) compared to those with continuously high drug concentrations (n = 11), distinct themes emerged related to HIV status disclosure, social support, interactions with the health system, and health beliefs. By combining ART biomarkers with patient reported challenges, there is the potential for real-time interventions to support sustained ART adherence among PPWH and improve maternal and infant health outcomes. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. Methods Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. Results In total, 511 patients were included [mean (s. d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: −0.04, 0.33) for 2 vs 0 visits; and +0.08 units (−0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. Conclusions In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome. [ABSTRACT FROM AUTHOR]

Current temperatures in microrefugia may persist longer than in nearby areas as temperatures warm. However, locating and measuring the contribution of microrefugia to thermal inertia in a landscape is challenging. We measured the thermal buffering capacity of microrefugia across a 40,000 km2 region of complex mountain topography by quantifying environmental lapse rate and solar radiation effects on air temperature in 0.1 km2 hexagons, a resource management‐relevant scale for climate adaptation. The greatest buffering capacity is −1.62°C, and only 2.8% of the region can buffer 1°C or greater. Historical loss of local cooling capacity is low, but by 2069 only 6.9%–11% of the region retains baseline temperature conditions. This thermal buffer index can find the most climate change‐buffered areas in lands identified as high priority for habitat conservation, wildlife corridors, and forest preservation. Other processes such as cold air pooling can complement our approach but depend on additional factors. Plain Language Summary: Microrefugia are areas where local climate conditions may persist longer as temperatures warm because of their topographic features, which include the level of solar radiation and the elevation range they contain. Such areas are of conservation interest because their potential to retain current climate conditions longer, as global warming continues may be of particular importance for species with low dispersal capabilities. We modeled these features across a large mountainous region using 10 ha (25 acre) hexagons. The use of a standard size permitted inter‐comparison of 404,700 units to identify their relative capacity to retain their climate conditions from a temporal baseline of 1981–2010. We found that warming between the 1951–1980 and the baseline only affected about 14% of the region. However, by 2069, only 6.9%–11% of the hexagons still retained the conditions from baseline period, and by 2100 less than 1% of the landscape retains the baseline temperature conditions. The identification of hexagons with the most temperature buffering capacity can inform a number of land management and conservation strategies. We illustrate their use in frameworks for preserving vegetation types, landscape connectivity protection, and late seral forest preservation. Key Points: Species with low dispersal capacity may depend on local microrefugia to persist as temperatures warmOver a 40,250 km2 area, we found that microrefugia buffering capacity at 10 ha scale is only retained in ∼6.9%–11% of the region by 2069Quantifying local capacity to retain baseline temperatures can be used in a variety of natural resource strategies for climate adaptation [ABSTRACT FROM AUTHOR]

The neutron and its hypothetical mirror counterpart, a sterile state degenerate in mass, could spontaneously mix in a process much faster than the neutron β-decay. Two groups have performed a series of experiments in search of neutron – mirror-neutron (n − n′) oscillations. They reported no evidence, thereby setting stringent limits on the oscillation time τnn′. Later, these data sets have been further analyzed by Berezhiani et al.(2009–2017), and signals, compatible with n − n′ oscillations in the presence of mirror magnetic fields, have been reported. The Neutron Electric Dipole Moment Collaboration based at the Paul Scherrer Institute performed a new series of experiments to further test these signals. In this paper, we describe and motivate our choice of run configurations with an optimal filling time of 29 s, storage times of 180 s and 380 s, and applied magnetic fields of 10 μT and 20 μT. The choice of these run configurations ensures a reliable overlap in settings with the previous efforts and also improves the sensitivity to test the signals. We also elaborate on the technique of normalizing the neutron counts, making such a counting experiment at the ultra-cold neutron source at the Paul Scherrer Institute possible. Furthermore, the magnetic field characterization to meet the requirements of this n − n′ oscillation search is demonstrated. Finally, we show that this effort has a statistical sensitivity to n − n′ oscillations comparable to the current leading constraints for B′ = 0.

We report on the strategy used to optimize the sensitivity of our search for a neutron electric dipole moment at the Paul Scherrer Institute. Measurements were made upon ultracold neutrons stored within a single chamber at the heart of our apparatus. A mercury cohabiting magnetometer together with an array of cesium magnetometers were used to monitor the magnetic field, which was controlled and shaped by a series of precision field coils. In addition to details of the setup itself, we describe the chosen path to realize an appropriate balance between achieving the highest statistical sensitivity alongside the necessary control on systematic effects. The resulting irreducible sensitivity is better than 1 × 10−26e cm. This contribution summarizes in a single coherent picture the results of the most recent publications of the collaboration.

We present the new spectrometer for the neutron electric dipole moment (nEDM) search at the Paul Scherrer Institute (PSI), called n2EDM. The setup is at room temperature in vacuum using ultracold neutrons. n2EDM features a large UCN double storage chamber design with neutron transport adapted to the PSI UCN source. The design builds on experience gained from the previous apparatus operated at PSI until 2017. An order of magnitude increase in sensitivity is calculated for the new baseline setup based on scalable results from the previous apparatus, and the UCN source performance achieved in 2016.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. Inflammatory polyarthritis is the primary clinical manifestation, mainly affecting small joints of the hands and the feet. (1) RA places significant [...], OBJECTIVES: Accurate data on the burden of rheumatoid arthritis (RA) are scarce, but critical in helping health care providers and decision makers to optimize clinical and public health strategies for disease management. We quantified the burden of RA in Ontario from 1996 to 2010 by age, sex and health planning region. METHODS: We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based cohort of all Ontarians with RA, to estimate the crude prevalence and incidence of RA among men and women, and by age group from 1996 to 2010. Burden by area of patient residence and rheumatology supply also were determined. RESULTS: The number of RA patients increased over time, from 42,734 Ontarians (0.5%) in 1996 to 97,499 (0.9%) in 2010. On average 5,830 new RA patients were diagnosed each year. In 2010, the burden was higher among females (1.3%) than males (0.5%) and increased with age, with almost half of all RA patients aged 65 years and older. The burden was higher in northern communities (1.0%) than in southern urban areas (0.7%). During the study period, the number of rheumatologists practicing in Ontario remained unchanged (approximately 160). CONCLUSION: Over a 15-year period, the number of RA patients more than doubled with no concomitant increase in the number of practicing rheumatologists. We observed considerable regional variation in burden, with the highest rates observed in the north. Our findings highlight the need for regional approaches to the planning and delivery of RA care in order to manage the growing burden. KEY WORDS: Rheumatoid arthritis; prevalence; incidence; health services OBJECTIFS: Les donnees precises sur le fardeau de la polyarthrite rhumato'i'de (PR) sont rares mais essentielles pour aider le personnel soignant et les decideurs a optimiser les strategies cliniques et de sante publique en gestion des soins therapeutiques. Nous avons chiffre le fardeau de la PR en Ontario de 1996 a 2010 selon l'age, le sexe et la region de planification sanitaire. METHODE: Nous avons utilise la base de donnees administratives sur la polyarthrite rhumato'i'de de l'Ontario (ORAD), une cohorte populationnelle validee de tous les Ontariens atteints de PR, pour estimer la prevalence et l'incidence brutes de la PR selon le sexe et le groupe d'age de 1996 a 2010. Nous avons aussi determine le fardeau de la maladie selon la region de residence des patients et l'offre en rhumatologie. RESULTATS: Le nombre de patients atteints de PR a augmente avec le temps, passant de 42 734 Ontariens (0,5 %) en 1996 a 97 499 (0,9 %) en 2010. En moyenne, 5 830 nouveaux patients par annee ont regu un diagnostic de PR. En 2010, le fardeau etait plus lourd chez les femmes (1,3 %) que chez les hommes (0,5 %), et il augmentait avec l'age: pres de la moitie des patients atteints de PR avaient 65 ans et plus. Le fardeau etait plus lourd dans les communautes nordiques (1,0 %) que dans les agglomerations urbaines du Sud (0,7 %). Sur la periode de l'etude, le nombre de rhumatologues exergant en Ontario est reste inchange (environ 160). CONCLUSION: Sur une periode de 15 ans, le nombre de patients atteints de PR a plus que double, sans augmentation comparable du nombre de rhumatologues en exercice. Nous avons releve des ecarts regionaux considerables dans le fardeau de la maladie, les plus hauts taux etant observes dans le Nord. Nos constatations soulignent le besoin d'approches regionales en matiere de planification et de prestation des soins de la PR afin de composer avec l'alourdissement du fardeau. MOTS CLES: polyarthrite rhumato'de; prevalence; incidence; services de sante La traduction du resume se trouve a la fin de l'article. Can J Public Health 2013;104(7):e450-e455.