Search

Background The long-term impact of universal home-based testing and treatment as part of universal testing and treatment (UTT) on HIV incidence is unknown. We made projections using a detailed individual-based model of the effect of the intervention delivered in the HPTN 071 (PopART) cluster-randomised trial. Methods In this modelling study, we fitted an individual-based model to the HIV epidemic and HIV care cascade in 21 high prevalence communities in Zambia and South Africa that were part of the PopART cluster-randomised trial (intervention period Nov 1, 2013, to Dec 31, 2017). The model represents coverage of home-based testing and counselling by age and sex, delivered as part of the trial, antiretroviral therapy (ART) uptake, and any changes in national guidelines on ART eligibility. In PopART, communities were randomly assigned to one of three arms: arm A received the full PopART intervention for all individuals who tested positive for HIV, arm B received the intervention with ART provided in accordance with national guidelines, and arm C received standard of care. We fitted the model to trial data twice using Approximate Bayesian Computation, once before data unblinding and then again after data unblinding. We compared projections of intervention impact with observed effects, and for four different scenarios of UTT up to Jan 1, 2030 in the study communities. Findings Compared with standard of care, a 51% (95% credible interval 40–60) reduction in HIV incidence is projected if the trial intervention (arms A and B combined) is continued from 2020 to 2030, over and above a declining trend in HIV incidence under standard of care. Interpretation A widespread and continued commitment to UTT via home-based testing and counselling can have a substantial effect on HIV incidence in high prevalence communities. Funding National Institute of Allergy and Infectious Diseases, US President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation, National Institute on Drug Abuse, and National Institute of Mental Health.

The HPTN 071 (PopART) trial of universal HIV testing and treatment to reduce HIV incidence was conducted in nine communities in South Africa and 12 in Zambia. The trial's primary outcome results were complicated to explain. Dissemination of these complicated results in participating communities in Zambia was done using a community dialogue approach. The approach, which involved interactive activities and a gradual and systematic approach to discussion of results in each community, facilitated respect and inclusion of participants in the dissemination process. The use of local language, pictures, images, and familiar analogies enhanced comprehension of the findings and created a two-way communication process between researchers and participants. The dialogue approach enabled both groups to use community perspectives, lived experiences, and local socio-structural features to interpret the trial results. Further, community members reflected on what the results meant to them individually and collectively. Although this community dialogue was both productive and appreciated, making this community interpretation apparent across disciplines in key quantitative scientific outputs remained a challenge.

BACKGROUND: Evidence suggests HSV-2 infection increases HIV acquisition risk and HIV/HSV-2 coinfection increases transmission risk of both infections. We analysed the potential impact of HSV-2 vaccination in South Africa, a high HIV/HSV-2 prevalence setting. METHODS: We adapted a dynamic HIV transmission model for South Africa to incorporate HSV-2, including synergistic effects with HIV, to evaluate the impact of: (i) cohort vaccination of 9-year-olds with a prophylactic vaccine that reduces HSV-2 susceptibility; (ii) vaccination of symptomatically HSV-2-infected individuals with a therapeutic vaccine that reduces HSV shedding. FINDINGS: An 80% efficacious prophylactic vaccine offering lifetime protection with 80% uptake could reduce HSV-2 and HIV incidence by 84.1% (95% Credibility Interval: 81.2-86.0) and 65.4% (56.5-71.6) after 40 years, respectively. This reduces to 57.4% (53.6-60.7) and 42.1% (34.1-48.1) if efficacy is 50%, 56.1% (53.4-58.3) and 41.5% (34.2-46.9) if uptake is 40%, and 29.4% (26.0-31.9) and 24.4% (19.0-28.7) if protection lasts 10 years. An 80% efficacious therapeutic vaccine offering lifetime protection with 40% coverage among symptomatic individuals could reduce HSV-2 and HIV incidence by 29.6% (21.8-40.9) and 26.4% (18.5-23.2) after 40 years, respectively. This reduces to 18.8% (13.7-26.4) and 16.9% (11.7-25.3) if efficacy is 50%, 9.7% (7.0-14.0) and 8.6% (5.8-13.4) if coverage is 20%, and 5.4% (3.8-8.0) and 5.5% (3.7-8.6) if protection lasts 2 years. INTERPRETATION: Prophylactic and therapeutic vaccines offer promising approaches for reducing HSV-2 burden and could have important impact on HIV in South Africa and other high prevalence settings. FUNDING: WHO, NIAID.

Shoulder examination may be tested during the MRCS OSCE. This article will describe the requirements of the clinical examination part of the OSCE as well as providing the candidate with a practical structure for examination of the shoulder. Foremost in the candidate's mind should be an idea of how they will be assessed and how to accrue marks. A clinical examination station not only tests fluent clinical examination, in the domains of ‘clinical knowledge’ and ‘technical skill’, but also assesses ‘communication skills’ and ‘professionalism. Ultimately, success in the MRCS OSCE is a combination of delivery of technical skill, clinical knowledge, good communication and professionalism. A technically flawless examination performed without regard to professional behaviour and good communication is unlikely to be good enough to pass. With that in mind, this article will cover all aspects of the shoulder examination from start to finish in more detail than required to give the depth of knowledge required to excel.

Soil emissions of nitrous oxide (N2O) are generally low in Australian semi-arid cropping systems, but can be reduced further by incorporating legumes into cereal-based rotations. We used automated and manual chambers to compare N2O emissions throughout a two-year legume-wheat field experiment. Two pulse crops [lupin (Lupinus angustifolius L.) and field pea (Pisum sativum L.)] and two forage legumes [vetch (Vicia sativa L.) and clover (a mixture of four Trifolium spp.)] were grown in the first year, followed by a wheat (Triticum aestivum L.) crop in the second year without additional nitrogen (N) fertilizer under either no-till or tillage systems. All legume crops were either (a) chemically terminated at anthesis (brown-manured, BM), or (b) cut for hay (forage legumes) or harvested for grain (pulses) (product-removed, PR). The fate of legume N in the BM treatment was traced using 15N labelled urea applied to soil in micro-plots. Results showed that N2O emissions during the legume and wheat phases were mostly unaffected by legume species, the exception being lower emissions from the BM clover pasture under the no-till treatment. Under the PR treatment, tillage tended to increase N2O emissions compared with the no-till treatment during both legume (121 vs. 104 g N2O-N ha−1 year−1) and wheat phases (91 vs. 79 g N2O-N ha−1 year−1). In contrast, a mixed result was found under the BM treatment with a significant tillage × crop management interaction during the legume phase, but no effect of tillage during the wheat phase. In general, the BM treatment promoted more N2O emissions due to more N input into soil compared to the PR treatment, with the impact extending into the subsequent wheat crop. The N2O emissions from the BM treatment during the legume (195 g N2O-N ha−1 year−1) and wheat phase (181 g N2O-N ha−1 year−1) were greater than those from the PR treatment for the corresponding phases (113 vs. 85 g N2O-N ha−1 year−1). The 15N study showed that the majority of legume-derived N was retained in the soil at the end of the legume phase and likely to be readily available for the subsequent cereal crop. The mitigation of N2O emissions derived from legumes in a semi-arid cereal-based cropping system can be optimized in a no-till system where product removal is practiced (cut for hay or harvested for grain) with legume species choice having little or no additional impact.

A pen feeding study was conducted using 10 month old Poll Dorset × Merino ewe lambs to test the effect of perennial wheat forage on growth rates and carcass characteristics in comparison to annual wheat forage. Individual lambs (n = 48) were fed one of four diets, namely perennial wheat (PW), annual wheat (W), perennial wheat + lucerne (alfalfa) (PW + L) or annual wheat + lucerne (W + L). Lambs were monitored for 28 days during which daily forage quality, forage mineral content, feed intake and weekly liveweight change were recorded. At the completion of the feeding period all lambs were slaughtered in a commercial abattoir. At 24 h post-slaughter the left hand side longissimus lumborum muscle (LL) was removed and assessed for quality attributes. Feed intake increased over the 28 days with W fed lambs eating a greater amount compared to PW fed lambs. The addition of lucerne to the cereal forage (PW + L and W + L) increased feed intake (P

The goal of this study was to evaluate the possibilities offered by a prototype HPLC column packed with ∼2.5 μm narrow size distribution sphere-on-sphere (SOS) silica particles bonded with C4 alkyl chains, for the analytical characterization of large biomolecules. The kinetic performance of this material was evaluated in both isocratic and gradient modes using various model analytes. The data were compared to those obtained on other widepore state-of-the-art fully core–shell and fully porous materials commonly employed to separate proteins moreover to a reference 5 μm wide pore material that is still often used in QC labs. In isocratic mode, minimum reduced plate height values of hmin = 2.6, 3.3 and 3.3 were observed on butylparaben, decapeptide and glucagon, respectively. In gradient elution mode, the SOS column performs very high efficiency when working with fast gradients. This prototype column was also comparable (and sometimes superior) to other widepore stationary phases, whatever the gradient time and flow rate, when analyzing the largest model protein, namely BSA. These benefits may be attributed to the SOS particle morphology, minimizing the intra-particle mass transfer resistance. Finally, the SOS column was also applied for the analytical characterization of commercial monoclonal antibody (mAb) and antibody-drug conjugate (ADC) samples. With these classes of proteins, the performance of SOS column was similar to the best widepore stationary phases available on the market.

The Harmonic Balance method is an attractive solution for computing periodic responses and can be an alternative to time domain methods, at a reduced computational cost. The current paper investigates using a Harmonic Balance method for simulating limit cycle oscillations under uncertainty. The Harmonic Balance method is used in conjunction with a non-intrusive polynomial-chaos approach to propagate variability and is validated against Monte Carlo analysis. Results show the potential of the approach for a range of nonlinear dynamical systems, including a full wing configuration exhibiting supercritical and subcritical bifurcations, at a fraction of the cost of performing time domain simulations.

The challenges in HPLC are fast and efficient separation for a wide range of samples. Fast separation often results in very high operating pressure, which places a huge burden on HPLC instrumentation. In recent years, core–shell silica microspheres (with a solid core and a porous shell, also known as fused-core or superficially porous microspheres) have been widely investigated and used for highly efficient and fast separation with reasonably low pressure for separation of small molecules, large molecules and complex samples. In this review, we firstly show the types of core–shell particles and how they are generally prepared, focusing on the methods used to produce core–shell silica particles for chromatographic applications. The fundamentals are discussed on why core–shell particles can perform better with low back pressure, in terms of van Deemter equation and kinetic plots. The core–shell particles are compared with totally porous silica particles and also monolithic columns. The use of columns packed with core–shell particles in different types of liquid chromatography is then discussed, followed by illustrating example applications of such columns for separation of various types of samples. The review is completed with conclusion and a brief perspective on future development of core–shell particles in chromatography.

This article examines patterns of entry and exit in a relatively homogeneous product market to investigate the impact of entry on incumbent firms and market structure. In particular, we are interested in whether the organizational form of entrants matters for the competitive decisions of incumbents. We assess the impact of chain stores on independent retailers in the Melbourne coffee market using annual data on the location and entry status of 4,768 coffee retailers between 1991 and 2010. The long panel enables us to include market fixed effects to address the endogeneity of store locations. Logit regressions indicate that chain stores have no discernible effect on the exit or entry decisions of independent stores. However, each additional chain store increases the probability of another chain store exiting by 2.5 percentage points, and each additional independent cafe increases the probability of another independent cafe exiting by 0.5 percent. These findings imply that neighboring independents and chains operate almost as though they are in separate markets. We offer additional analysis suggesting consumer information as a cause of this differentiation.

This study evaluated over 150 wheat x wheatgrass derivatives in a series of field experiments. The objective was to assess their capacity to regrow post-harvest and yield grain over successive years, and thereby identify characteristics common to the surviving breeding lines. Over the 3-year experimental period 61% of the 176 experimental entries demonstrated some capacity for post-harvest regrowth. Of 125 entries planted in the first two years of experimentation, 34% persisted to produce a second grain harvest in year 2. Three entries from 73 planted in 2008 persisted to produce grain in 3 successive years. In a subset of 87 entries that underwent cytogenetic analysis there was an association between regrowth ability and the presence of at least one whole genome equivalent (14 chromosomes) from the perennial donor species. If the wheat parent was a hexaploid (2n = 42), an entry required at least 56 chromosomes to achieve any substantial post-harvest regrowth. However, the presence of 56 chromosomes was no guarantee of a capacity to survive post-harvest. The morphology of the hybrid germplasm was highly variable for every trait assessed including grain yield, grain size, grain quality, harvest index, tiller height and head morphology; reflective of the diversity of pedigrees. Narrower kernels appeared to be associated with higher grain protein concentrations. Unextractable polymeric protein (UPP) correlates with rheological properties of the doughs; some of the experimental entries had very low UPP; the majority had high UPP suggesting useful flour, dough and baking properties. A high level of disease resistance was observed in the subset of entries tested for leaf, stem and stripe rust as well as wheat streak mosaic virus, indicating that further development of hybrid germplasm would be unlikely to pose an unacceptable disease threat to conventional cereal crops, particularly where amphiploids were deployed. The variability of the cohort and the presence of entries with desirable agronomic and grain quality attributes suggested a potential to breed and select for perennial wheat derivatives with commercially desirable characteristics. (C) 2012 Elsevier B.V. All rights reserved.

In southern New South Wales, Australia, farming operations using tractors often occur when the soils are moist and prone to soil compaction. However, the extent of soil compaction and its relative impact on crop yield have not been quantified in the region. In this experiment, re-compaction due to tractor wheel traffic in a sodic brown clay (Vertisol) was monitored under simulated controlled traffic conditions after removal of a pre-existing subsoil pan by deep tillage. Soil physical properties under wheel tracks were compared to those between wheel tracks in terms of bulk density, penetrometer resistance, water content, airfilled porosities and changes in ‘‘least limiting water range’’. Differences in the growth and yield of canola (Brassica napus) and wheat (Triticum aestivum) in the two areas were also measured. Although deep ripping increased canola yield by 20% (from 2.0 to 2.4 t ha 1 ), reformation of a compaction pan under the wheel tracks was already detected in the first season of cropping. In the second cropping year, soil in the 0.05‐0.10 m layer under wheel tracks had significantly higher penetrometer resistance (>2000 kPa) and bulk density (1.5‐1.58 Mg m 3 ) and lower air-filled porosity (0.07‐0.09 m 3 m 3 ) compared to that measured between wheel tracks (

s r d q P r t c r n essai randomise en cluster est un essai dans lequel ’attribution aleatoire des traitements (ou des intervenions) se fait au niveau de clusters (ou groupes) de articipants, plutot que des participants eux-memes [1]. Ce chema experimental a connu son plein essor au cours des 0 dernieres annees [2]. Les essais randomises en cluster ont meme l’objet d’une extension du CONSORT Stateent [3]. Le CONSORT Statement (Consolidated Standards f Reporting Trials) ainsi que ses extensions regroupent les ecommandations de redaction, specifiques a chaque type ’essai, ayant pour but l’amelioration de la qualite de la edaction des articles [4].

The observation that platelet-platelet interaction and thrombosis are ultimately regulated by the glycoprotein (GP) IIb/IIIa receptor complex, triggered the development of agents capable of interfering with this platelet receptor complex. Several large clinical trials have demonstrated the effectiveness of this class of agents. The first of these agents to show beneficial effects after coronary interventions was the mouse/human chimeric Fab fragment antibody c7E3 (abciximab; ReoPro). This study analyzes whether the addition of heparin to the GP IIb/IIIa antagonist abciximab would enhance the antithrombotic effect. Blood drawn directly from patients on aspirin who underwent interventional procedures perfused an ex vivo perfusion chamber containing a severely injured arterial wall at local rheologic conditions of a mildly stenosed coronary artery. Blood was perfused directly from patients at baseline and following administration of heparin, abciximab, or both. The antithrombotic effects of the 3 treatments were assessed by reduction of the thrombus formation on the perfused specimens. Thrombus formation at baseline was not significantly modified by the administration of heparin (13,897 6 1,316 vs 11,917 6 1,519 mm 2 ). Abciximab produced a 58% reduction in thrombus formation (11,631 6 861 vs 4,925 6 585 mm 2 ;p

This report looks at some of the methodological considerations in valuing the benefits of broadband. It has a particular focus on these considerations in the context of the planned National Broadband Network (NBN) project in Australia and in the context of any social cost benefit analysis of the NBN or other broadband project. While the underlying principles of valuation are transferable to a variety of project settings, here they are discussed primarily with reference to the planned NBN.

After the removal of no surcharging rules, average credit card interchange fees in Australia were cut almost in half in 2003 as part of a suite of credit card industry reforms, aimed at reducing the relative attractiveness of credit card use. This paper tests whether the reforms are associated with a negative structural break in credit card use. The exogenous and endogenous break point tests do not support a negative structural break in credit card usage levels, growth rates or market shares at the time of the reforms. This provides support for the interchange fee being neutral under surcharging.