Search

ObjectiveTo evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa.DesignProspective cohort study.SettingPrimary and secondary level health facilities in Neno District, Malawi.ParticipantsNew adult enrollees in Integrated Chronic Care Clinics (IC3) between July 2016 and June 2017.Main outcome measuresWe quantified the annualised total and per capita economic cost (US$2017) of integrated chronic care, using activity-based costing from a health system perspective. We also measured enrolment, retention and mortality over the same period. Furthermore, we measured clinical outcomes for HIV (viral load), hypertension (controlled blood pressure), diabetes (average blood glucose), asthma (asthma severity) and epilepsy (seizure frequency).ResultsThe annualised total cost of providing integrated HIV and NCD care was $2 461 901 to provide care to 9471 enrollees, or $260 per capita. This compared with $2 138 907 for standalone HIV services received by 6541 individuals, or $327 per capita. Over the 12-month period, 1970 new clients were enrolled in IC3, with a retention rate of 80%. Among clients with HIV, 81% achieved an undetectable viral load within their first year of enrolment. Significant improvements were observed among clinical outcomes for clients enrolled with hypertension, asthma and epilepsy (p0.05).ConclusionsIC3 is one of the largest examples of fully integrated HIV and NCD care. Integrating screening and treatment for chronic health conditions into Malawi’s HIV platform appears to be a financially feasible approach associated with several positive clinical outcomes.

Liberia has an extreme health workforce shortage, particularly with respect to surgery. JJ Dossen Memorial (JJD) is a public referral hospital supported by Partners in Health. We designed and implemented a comprehensive surgical program at JJD. Using case logs, clinic records, and transfer data between December 2016 and April 2018, we evaluated the impact of this program on the surgical cohort and examined temporal trends in patient origin using GIS. The mean number of cases per day increased from 1.7 ± 1.0 to 2.4 ± 1.3 (p

Chemically tagging stars back to common formation sites in the Milky Way and establishing a high level of chemical homogeneity in these chemically tagged birth clusters is crucial for understanding the chemical and dynamical history of the Galactic disc. We constrain the intrinsic abundance scatter in 17 newly chemically tagged dissolved birth clusters found in the APOGEE survey by modelling APOGEE spectra as a one-dimensional function of initial stellar mass, performing forward modelling of the observed stellar spectra, then comparing the data and simulations using Approximate Bayesian Computation. We exemplify this method with the well-known open clusters M67, NGC 6819, and NGC 6791. We study 15 elements measured by APOGEE and find that, in general, we are able to obtain very strong constraints on the intrinsic abundance scatter of most elements in the chemically tagged birth clusters, with upper limits of $\lesssim 0.02$ dex for C, $\lesssim 0.03$ dex for O, Mn, and Fe, $\lesssim 0.04$ dex for Si and Ni, and $\lesssim 0.05$ dex for N, Mg, and Ca. While we find some evidence for a small amount of chemical inhomogeneity in the remaining elements (i.e. Na, Al, S, K, Ti, and V), we are still able to obtain similar or stronger limits compared to those found for open clusters, consistent with previous findings. By strongly constraining their level of chemical homogeneity, we can strengthen the statement that these groups of stars represent birth clusters, with promising implications for future chemical tagging studies., MNRAS, in press

ObjectivesNon-communicable diseases (NCDs) account for one-third of disability-adjusted life years in Malawi, and access to care is exceptionally limited. Integrated services with HIV are widely recommended, but few examples exist globally. We report descriptive outcomes from an Integrated Chronic Care Clinic (IC3).DesignThis is a retrospective cohort study.SettingThe study includes an HIV–NCD clinic across 14 primary care facilities in the rural district of Neno, Malawi.ParticipantsAll new patients, including 6233 HIV–NCD diagnoses, enrolled between January 2015 and December 2017 were included. This included 3334 patients with HIV (59.7% women) and 2990 patients with NCD (67.3% women), 10% overall under age 15 years.InterventionsPatients were seen at their nearest health centre, with a hospital team visiting routinely to reinforce staffing. Data were collected on paper forms and entered into an electronic medical record.Primary and secondary outcome measuresRoutine clinical measurements are reported at 1-year post-enrolment for patients with more than one visit. One-year retention is reported by diagnosis.ResultsNCD diagnoses were 1693 hypertension, 668 asthma, 486 epilepsy, 149 diabetes and 109 severe mental illness. By December 2018, 8.3% of patients with NCD over 15 years were also on HIV treatment. One-year retention was 85% for HIV and 72% for NCDs, with default in 8.4% and 25.5% and deaths in 4.0% and 1.4%, respectively. Clinical outcomes showed statistically significant improvement for hypertension, diabetes, asthma and epilepsy. Of the 1807 (80%) of patients with HIV with viral load results, 85% had undetectable viral load.ConclusionsThe IC3 model, built on an HIV platform, facilitated rapid decentralisation and access to NCD services in rural Malawi. Clinical outcomes and retention in care are favourable, suggesting that integration of chronic disease care at the primary care level poses a way forward for the large dual burden of HIV and chronic NCDs.

The federal government shutdown from 22 December 2018 to 25 January 2019 created an unprecedented disruption in Supplemental Nutrition Assistance Program (SNAP) benefits. We conducted a cross-sectional qualitative study to begin to capture how the disruption affected food security and wellbeing among a small sample of California SNAP participants. We collected data from 26 low-income adults in four focus groups in four diverse California counties. We found that participants routinely struggle to secure an adequate and healthy diet in the context of high costs of living, the shutdown and benefit disruption added to participants&rsquo, stress and uncertainty and exacerbated food insecurity, and it diminished some participants&rsquo, faith in government. Participants reported that, while having additional benefits in January felt like a relief from typical end-of-month deprivation, the subsequent extended gap between benefit distributions and a lack of clarity about future benefits caused cascading effects as participants later had to divert money from other expenses to buy food and faced added uncertainty about future economic stability. Additionally, the shutdown highlighted challenges related to the availability, timing, and tone of communications between participants and SNAP agencies. Participants recommended that SNAP adjust benefit and eligibility levels to better address costs of living, improve customer service, and avoid future disruptions.

Chemically tagging groups of stars born in the same birth cluster is a major goal of spectroscopic surveys. To investigate the feasibility of such strong chemical tagging, we perform a blind chemical tagging experiment on abundances measured from APOGEE survey spectra. We apply a density-based clustering algorithm to the eight dimensional chemical space defined by [Mg/Fe], [Al/Fe], [Si/Fe], [K/Fe], [Ti/Fe], [Mn/Fe], [Fe/H], and [Ni/Fe], abundances ratios which together span multiple nucleosynthetic channels. In a high quality sample of 182,538 giant stars, we detect twenty-one candidate clusters with more than fifteen members. Our candidate clusters are more chemically homogeneous than a population of non-member stars with similar [Mg/Fe] and [Fe/H], even in abundances not used for tagging. Group members are consistent with having the same age and fall along a single stellar-population track in logg vs. Teff space. Each group's members are distributed over multiple kpc, and the spread in their radial and azimuthal actions increases with age. We qualitatively reproduce this increase using N-body simulations of cluster dissolution in Galactic potentials that include transient winding spiral arms. Observing our candidate birth clusters with high-resolution spectroscopy in other wavebands to investigate their chemical homogeneity in other nucleosynthetic groups will be essential to confirming the efficacy of strong chemical tagging. Our initially spatially-compact but now widely dispersed candidate clusters will provide novel limits on chemical evolution and orbital diffusion in the Galactic disc, and constraints on star formation in loosely-bound groups., 15 pages, 9 figures, accepted by MNRAS

Background The California Expanded Food and Nutrition Education Program (CA EFNEP) provides nutrition education to low-income parents, and evaluates outcomes in nutrition practices (NP), food resource management practices (FRMP), food safety practices (FSP), and food security (FS) (not running out of food before the end of the month). Objective To examine the association between poverty, education and improvements in NP, FRMP, FSP, and FS. Study Design, Settings, Participants This study utilized pre-post-secondary data analysis including 19,190 CA EFNEP participants (FFY 2014-2017 Food Behavior Checklist), who were female (93%) and Hispanic (80.3%). Twenty percent of participants who completed the program reported less than a 6th grade education and 25% lived in extreme poverty (below 50% of the Federal Poverty Level, FPL). Measurable Outcome/Analysis Paired sample t tests were used to examine participant outcomes at pretest and posttest. To examine the association between demographic characteristics and improvement in NP, FRMP, FSP and FS, we ran repeated measures ANOVA to compare within-subject means across demographic characteristics, comparing participants in the highest and lowest quartiles. Results EFNEP participation was associated with improvements in NP, FRMP, FSP, and FS (P Conclusion Findings indicate that CA EFNEP is effective in improving the health outcomes of its most vulnerable participants. Further research is needed to examine the association between EFNEP outcomes and participant food security status, using multiple FS indicators.

We make use of APOGEE and $Gaia$ data to identify stars that are consistent with being born in the same association or star cluster as the Sun. We limit our analysis to stars that match solar abundances within their uncertainties, as they could have formed from the same Giant Molecular Cloud (GMC) as the Sun. We constrain the range of orbital actions that solar siblings can have with a suite of simulations of solar birth clusters evolved in static and time-dependent tidal fields. The static components of each galaxy model are the bulge, disk, and halo, while the various time-dependent components include a bar, spiral arms, and GMCs. In galaxy models without GMCs, simulated solar siblings all have $J_R < 122$ km $\rm s^{-1}$ kpc, $990 < L_z < 1986$ km $\rm s^{-1}$ kpc, and $0.15 < J_z < 0.58$ km $\rm s^{-1}$ kpc. Given the actions of stars in APOGEE and $Gaia$, we find 104 stars that fall within this range. One candidate in particular, Solar Sibling 1, has both chemistry and actions similar enough to the solar values that strong interactions with the bar or spiral arms are not required for it to be dynamically associated with the Sun. Adding GMCs to the potential can eject solar siblings out of the plane of the disk and increase their $J_z$, resulting in a final candidate list of 296 stars. The entire suite of simulations indicate that solar siblings should have $J_R < 122$ km $\rm s^{-1}$ kpc, $353 < L_z < 2110$ km $\rm s^{-1}$ kpc, and $J_z < 0.8$ km $\rm s^{-1}$ kpc. Given these criteria, it is most likely that the association or cluster that the Sun was born in has reached dissolution and is not the commonly cited open cluster M67., 12 pages, 9 figures, 3 tables, Accepted for publication in MNRAS

Chemical tagging has great promise as a technique to unveil our Galaxy's history. Grouping stars based on their similar chemistry can establish details of the star formation and merger history of the Milky Way. With precise measurements of stellar chemistry, chemical tagging may be able to group together stars born from the same gas cloud, regardless of their current positions and kinematics. Successfully tagging these birth clusters requires high quality chemical space information and a good cluster-finding algorithm. To test the feasibility of chemical tagging on data from current and upcoming spectroscopic surveys, we construct a realistic set of synthetic clusters, creating both observed spectra and derived chemical abundances for each star. We use Density-Based Spatial Clustering of Applications with Noise (DBSCAN) to group stars based on their spectra or abundances; these groups are matched to input clusters and are found to be highly homogeneous and complete. The percentage of clusters with more than 10 members recovered is 40% when tagging on abundances with uncertainties achievable with current techniques. Based on our fiducial model for the Milky Way, we predict recovering over 600 clusters with at least 10 observed members and 70% membership homogeneity in a sample similar to the APOGEE survey. Tagging larger surveys like the GALAH survey and the future Milky Way Mapper in SDSS V could recover tens of thousands of clusters at high homogeneity. Access to so many unique co-eval clusters will transform how we understand the star formation history and chemical evolution of our Galaxy., Comment: 16 pages, 10 figures, accepted for publication in MNRAS

NGC 288 is a Galactic globular cluster having observed extra tidal structure, without confirmed tidal tails. $Gaia$ DR2 provides photometric and astrometric data for many of the stars in NGC 288 and its extra tidal structure. To compare with $Gaia$ data, we simulate an $N$-body model of a star cluster with the same orbit as NGC 288 in a Milky Way potential. The simulation shows that the cluster forms tidal tails that are compressed along the cluster's orbit when it is at apocentre and are expected to be a diffuse bipolar structure. In this letter, we present a comparison between the simulation and observations from $Gaia$ DR2. We find that both the simulation and the observations share comparable trends in the position on the sky and proper motions of the extra-tidal stars, supporting the presence of tidal tails around NGC 288., Comment: 5 pages, 5 figures

Objective To improve youth nutrition knowledge and behaviors by implementing and evaluating the USDA Expanded Food and Nutrition Education Program (EFNEP). EFNEP teaches youth how to develop healthy eating habits, increase physical activity, and practice safe food handling. Use of Theory or Research School-based nutrition education programs have demonstrated effectiveness in improving dietary habits and increasing fruit and vegetable consumption. Research shows that low-income communities suffer from higher rates of pediatric obesity. Target Audience Low-income youth (ages 5-18) in Los Angeles County. Program Description Trained nutrition educators implemented a six-lesson nutrition class series in schools, after-school programs, or summer programs. Alternately, nutrition educators trained and supported teachers or agency-paid staff to implement the lesson series. Classes were typically held once a week for one hour. The curriculum used varied by grade-level; all curriculum was developed and tested by the University of California and collaborators. Evaluation Methods Randomly selected program participants completed pre/post lesson evaluations. Four separate evaluation tools were used to evaluate students across grade levels. National EFNEP designed and tested the evaluation tools. Results In Federal Fiscal Year 2107/2018 Los Angeles EFNEP graduated 6,761 youth, and selected 1,295 participants to evaluate. Eighty-one percent of evaluated youth improved their abilities to choose foods according to Federal Dietary Recommendations or gained knowledge, 42% improved their physical activity practices or gained knowledge and 44% used safe food handling practices more often or gained knowledge. Improvements were greatest for 9th-12th grade youth, where 99% improved in one or more core area. K-2nd grade youth experienced lower results: 80% improved in one or more core area. Conclusions Los Angeles EFNEP is successful in improving the nutrition, physical activity and food safety knowledge of urban low-income youth. Improvements in knowledge appear to be greater for older youth; more research is needed to determine if these differences are significant. This research has implications for future nutrition education program development including effective targeting of health education topics by grade level. Funding None.

Chemical tagging of stars based on their similar compositions can offer new insights about the star formation and dynamical history of the Milky Way. We investigate the feasibility of identifying groups of stars in chemical space by forgoing the use of model derived abundances in favour of direct analysis of spectra. This facilitates the propagation of measurement uncertainties and does not presuppose knowledge of which elements are important for distinguishing stars in chemical space. We use ~16,000 red-giant and red-clump H-band spectra from the Apache Point Observatory Galactic Evolution Experiment and perform polynomial fits to remove trends not due to abundance-ratio variations. Using expectation maximized principal component analysis, we find principal components with high signal in the wavelength regions most important for distinguishing between stars. Different subsamples of red-giant and red-clump stars are all consistent with needing about 10 principal components to accurately model the spectra above the level of the measurement uncertainties. The dimensionality of stellar chemical space that can be investigated in the H-band is therefore $\lesssim 10$. For APOGEE observations with typical signal-to-noise ratios of 100, the number of chemical space cells within which stars cannot be distinguished is approximately $10^{10\pm2} \times (5\pm 2)^{n-10}$ with $n$ the number of principal components. This high dimensionality and the fine-grained sampling of chemical space are a promising first step towards chemical tagging based on spectra alone., 16 pages, 12 figures, accepted to MNRAS Dec 2017

The fourth generation of the Sloan Digital Sky Survey (SDSS-IV) began observations in July 2014. It pursues three core programs: APOGEE-2,MaNGA, and eBOSS. In addition, eBOSS contains two major subprograms: TDSS and SPIDERS. This paper describes the first data release from SDSS-IV, Data Release 13 (DR13), which contains new data, reanalysis of existing data sets and, like all SDSS data releases, is inclusive of previously released data. DR13 makes publicly available 1390 spatially resolved integral field unit observations of nearby galaxies from MaNGA,the first data released from this survey. It includes new observations from eBOSS, completing SEQUELS. In addition to targeting galaxies and quasars, SEQUELS also targeted variability-selected objects from TDSS and X-ray selected objects from SPIDERS. DR13 includes new reductions ofthe SDSS-III BOSS data, improving the spectrophotometric calibration and redshift classification. DR13 releases new reductions of the APOGEE-1data from SDSS-III, with abundances of elements not previously included and improved stellar parameters for dwarf stars and cooler stars. For the SDSS imaging data, DR13 provides new, more robust and precise photometric calibrations. Several value-added catalogs are being released in tandem with DR13, in particular target catalogs relevant for eBOSS, TDSS, and SPIDERS, and an updated red-clump catalog for APOGEE.This paper describes the location and format of the data now publicly available, as well as providing references to the important technical papers that describe the targeting, observing, and data reduction. The SDSS website, http://www.sdss.org, provides links to the data, tutorials and examples of data access, and extensive documentation of the reduction and analysis procedures. DR13 is the first of a scheduled set that will contain new data and analyses from the planned ~6-year operations of SDSS-IV. Postprint

Current quality control of earth construction in developing and disaster areas is very basic, relying on highly operator-dependent, non-standardised tests. The uncertainty in material properties has led to over-conservative design, increasing construction costs where it can least be afforded. The development of a quality control kit is described; to be fit for purpose it had to be cheap and easy to use. The equipment included had to be portable, resilient and independent of mains power. The hydrometer and Atterberg limit test methods from BS 1377 (soil investigation) are slightly modified to be more suitable for field application. The modified methods are deemed acceptable if they provide sufficient accuracy to be useful as a design tool. In an adaptation of cement mortar tests, the compressive strength of bricks or blocks is tested over a 100 mm × 100 mm area. This has been shown to give safe but not over-conservative values of strength using portable equipment. The report concludes that an accurate, quantitative kit can be compiled for under £350 (US$560), excluding labour for its construction, with a mass of 10–25 kg, depending on the types of tests required. This is less than the mass of soil and blocks required for equivalent tests in a commercial laboratory.

Folic acid enhances endothelial function and improves outcome in primary prevention of cardiovascular disease. The exact intracellular signalling mechanisms involved remain elusive and were therefore the subject of this study. Particular focus was placed on folic acid-induced changes in posttranslational modifications of endothelial nitric oxide synthase (eNOS). Cultured endothelial cells were exposed to folic acid in the absence or presence of phosphatidylinositol-3' kinase/Akt (PI3K/Akt) inhibitors. The phosphorylation status of eNOS was determined via western blotting. The activities of eNOS and PI3K/Akt were evaluated. The interaction of eNOS with caveolin-1, Heat-Shock Protein 90 and calmodulin was studied using co-immunoprecipitation. Intracellular localisation of eNOS was investigated using sucrose gradient centrifugation and confocal microscopy. Folic acid promoted eNOS dephosphorylation at negative regulatory sites, and increased phosphorylation at positive regulatory sites. Modulation of phosphorylation status was concomitant with increased cGMP concentrations, and PI3K/Akt activity. Inhibition of PI3K/Akt revealed specific roles for this kinase pathway in folic acid-mediated eNOS phosphorylation. Regulatory protein and eNOS protein associations were altered in favour of a positive regulatory effect in the absence of bulk changes in intracellular eNOS localisation. Folic acid-mediated eNOS activation involves the modulation of eNOS phosphorylation status at multiple residues and positive changes in important protein–protein interactions. Such intracellular mechanisms may in part explain improvements in clinical vascular outcome following folic acid treatment.

Molecular phylogenetic relationships within the Chlorophyta have relied heavily on rRNA data. These data have revolutionized our insight in green algal evolution, yet some class relationships have never been well resolved. A commonly used class within the Chlorophyta is the Ulvophyceae, although there is not much support for its monophyly. The relationships among the Ulvophyceae, Trebouxiophyceae, and Chlorophyceae are also contentious. In recent years, chloroplast genome data have shown their utility in resolving relationships between the main green algal clades, but such studies have never included marine macroalgae. We provide partial chloroplast genome data (∼30,000 bp, 23 genes) of the ulvophycean macroalga Caulerpa filiformis (Suhr) K. Herig. We show gene order conservation for some gene combinations and rearrangements in other regions compared to closely related taxa. Our data also revealed a pseudogene (ycf62) in Caulerpa species. Our phylogenetic results, based on analyses of a 23-gene alignment, suggest that neither Ulvophyceae nor Trebouxiophyceae are monophyletic, with Caulerpa being more closely related to the trebouxiophyte Chlorella than to Oltmannsiellopsis and Pseudendoclonium.

Objective To measure the association between the number of doctors, nurses and hospital beds per 10,000 people and individual HIV-infected patient outcomes in Botswana. Design Analysis of routinely collected longitudinal data from 97,627 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. Doctors, nurses, and hospital bed density data at district-level were collected from various sources. Methods A multilevel, longitudinal analysis method was used to analyze the data at both patient- and district-level simultaneously to measure the impact of the health system input at district-level on probability of death or loss-to-follow-up (LTFU) at the individual level. A marginal structural model was used to account for LTFU over time. Results Increasing doctor density from one doctor to two doctors per 10,000 population decreased the predicted probability of death for each patient by 27%. Nurse density changes from 20 nurses to 25 nurses decreased the predicted probability of death by 28%. Nine percent decrease was noted in predicted mortality of an individual in the Masa program for every five hospital bed density increase. Conclusion Considerable variation was observed in doctors, nurses, and hospital bed density across health districts. Predictive margins of mortality and LTFU were inversely correlated with doctor, nurse and hospital bed density. The doctor density had much greater impact than nurse or bed density on mortality or LTFU of individual patients. While long-term investment in training more healthcare professionals should be made, redistribution of available doctors and nurses can be a feasible solution in the short term.

Molecular phylogenetic relationships within the Chlorophyta have relied heavily on rRNA data. These data have revolutionized our insight in green algal evolution, yet some class relationships have never been well resolved. A commonly used class within the Chlorophyta is the Ulvophyceae, although there is not much support for its monophyly. The relationships among the Ulvophyceae, Trebouxiophyceae, and Chlorophyceae are also contentious. In recent years, chloroplast genome data have shown their utility in resolving relationships between the main green algal clades, but such studies have never included marine macroalgae. We provide partial chloroplast genome data (30,000 bp, 23 genes) of the ulvophycean macroalga Caulerpa filiformis (Suhr) K. Herig. We show gene order conservation for some gene combinations and rearrangements in other regions compared to closely related taxa. Our data also revealed a pseudogene (ycf62 )i nCaulerpa species. Our phylogenetic results, based on analyses of a 23-gene alignment, suggest that neither Ulvophyceae nor Trebouxiophyceae are monophyletic, with Caulerpa being more closely related to the trebouxiophyte Chlorella than to Oltmannsiellopsis and Pseudendoclonium.

To determine the incidence and risk factors of mortality for all HIV-infected patients receiving antiretroviral treatment at public and private healthcare facilities in the Botswana National HIV/AIDS Treatment Programme.We studied routinely collected data from 226 030 patients enrolled in the Botswana National HIV/AIDS Treatment Programme from 2002 to 2013.A person-years (P-Y) approach was used to analyse all-cause mortality and follow-up rates for all HIV-infected individuals with documented antiretroviral therapy initiation dates. Marginal structural modelling was utilized to determine the effect of treatment on survival for those with documented drug regimens. Sensitivity analyses were performed to assess the robustness of our results.Median follow-up time was 37 months (interquartile range 11-75). Mortality was highest during the first 3 months after treatment initiation at 11.79 (95% confidence interval 11.49-12.11) deaths per 100 P-Y, but dropped to 1.01 (95% confidence interval 0.98-1.04) deaths per 100 P-Y after the first year of treatment. Twelve-month mortality declined from 7 to 2% of initiates during 2002-2012. Tenofovir was associated with lower mortality than stavudine and zidovudine.The observed mortality rates have been declining over time; however, mortality in the first year, particularly first 3 months of antiretroviral treatment, remains a distinct problem. This analysis showed lower mortality with regimens containing tenofovir compared with zidovudine and stavudine. CD4 cell count less than 100 cells/μl, older age and being male were associated with higher odds of mortality.

Objective To evaluate the variation in all-cause attrition (mortality and loss to follow-up (LTFU)) among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program. Methods Analysis of routinely collected longitudinal data from 226030 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. A time-to-event analysis was used to measure crude mortality and loss to follow-up rates (LTFU). A marginal structural model was used to evaluate mortality and LTFU rates by district over time adjusted for individual-level risk factors (e.g. age gender baseline CD4 year of treatment initiation and antiretroviral regimen). Results Mortality rates in the districts ranged from the lowest 1.0 (95% CI 0.9-1.1) in Selibe-Phikwe to the highest 5.0 (95% CI 4.0-6.1) in Mabutsane. There was a wide range of overall LTFU across districts including rates as low as 4.6 (95% CI 4.4-4.9) losses per 100 person-years in Ngamiland and 5.9 (95% CI 5.6-6.2) losses per 100 person-years in South East to rates as high as 25.4 (95% CI 23.08-27.89) losses per 100 person-years in Mabutsane and 46.3 (95% CI 43.48-49.23) losses per 100 person-years in Okavango. Even when known risk factors for mortality and LTFU were adjusted for district was a significant predictor of both mortality and LTFU rates Conclusion We found statistically significant variation in attrition (mortality and LTFU) and data quality among districts. These findings suggest that district-level contextual factors affect retention in treatment. Further research needs to investigate factors that can potentially cause this variation.

Arup are developing arcoBridge, a new modular glass fibre reinforced polymer (GFRP) footbridge designed with a view to accessing the UK rail market. The bridge’s unique modular and post-tensioned design has several advantages over existing steel, concrete and composite designs. Compared to Steel and Concrete, the lightweight bridges require smaller cranes and can be transported to sites with difficult access without costly haul roads. Arup’s initial costs are lower than other GFRP options due to the smaller tooling, QA and workshop size requirements. The bridge has been designed with a design-for-manufacture philosophy. Working in sympathy with the materials has led to a number of novel design features for a GFRP bridge. These include the incorporation of a post-tensioning system and a patented shear joint design. These features create a stress-state dominated by compression, thus simplifying the design process considerably. In this paper an overview of the on-going design and testing work is presented, as Arup work towards delivering a 15m span prototype in September 2015. It includes a description of arcoBridge’s novel design features and the laboratory testing that has been performed as validation to date. Further, the paper explains a novel technique, involving full scale factory testing of the first bridge built by each supplier to enable the GFRP structure to be supplied conforming to Eurocode reliability. This is possible even without a published code for this material. Keywords: Composites, GFRP, Footbridges, Post-tensioning, Eurocode List of symbols

Background Time series models can play an important role in disease prediction. Incidence data can be used to predict the future occurrence of disease events. Developments in modeling approaches provide an opportunity to compare different time series models for predictive power. Results We applied ARIMA and Random Forest time series models to incidence data of outbreaks of highly pathogenic avian influenza (H5N1) in Egypt, available through the online EMPRES-I system. We found that the Random Forest model outperformed the ARIMA model in predictive ability. Furthermore, we found that the Random Forest model is effective for predicting outbreaks of H5N1 in Egypt. Conclusions Random Forest time series modeling provides enhanced predictive ability over existing time series models for the prediction of infectious disease outbreaks. This result, along with those showing the concordance between bird and human outbreaks (Rabinowitz et al. 2012), provides a new approach to predicting these dangerous outbreaks in bird populations based on existing, freely available data. Our analysis uncovers the time-series structure of outbreak severity for highly pathogenic avain influenza (H5N1) in Egypt.