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This study evaluated the effects of nutrient density and the usage of a multicarbohydrase containing α-galactosidase enzyme (CAG) on broiler performance, carcass characteristics, and nutrient utilization from 1 to 42 d of age. A total of 1,800 d-old YPM x Ross 708 male broilers were distributed randomly into 72 floor pens (25 birds/pen) and assigned to 1 of 6 treatments (12 replicates/treatment). Three basal diets were formulated with 2 ME levels (adequate (AE) and 100 kcal/kg reduced (RE)) and 2 amino acid (AA) densities (96 and 90%) following Ross 708 nutrient specifications. The first diet, AE96AA, contained AE and 96% AA density. The second diet, RE96AA, contained RE with 96% AA density. The third diet, RE90AA, contained RE with 90% AA density. Additional treatments were prepared by supplementing 0.2 g CAG per kg feed to the basal diets. Broiler performance (d 14, 28, and 42), processing yields (d 43), breast myopathies (d 43), apparent ileal nutrient digestibility (d 42), and digestible nutrient intake (d 29 to 42) were determined. Data were analyzed as a 3 × 2 (nutrient density x CAG) factorial arrangement of treatments. Nutrient density x CAG interactions were observed for multiple measurements including feed conversion ratio (FCR; d 1 to 42), CP digestibility, and apparent ileal digestible energy (AIDE). Day 1 to 42 FCR was reduced when broilers were fed RE90AA with CAG compared to RE90AA without CAG (P ≤ 0.05). Crude protein digestibility increased when broilers consumed AE96AA without CAG compared to RE90AA, whereas CAG inclusion allowed for similar CP digestibility between all nutrient densities (P ≤ 0.05). Without CAG inclusion, AIDE had a stepwise decrease from AE96AA to RE90AA, while CAG supplemented AE96AA and RE90AA had similar AIDE (P ≤ 0.05). Inclusion of CAG decreased FCR, and increased nutrient digestibility of broilers fed nutrient-reduced diets.

Summary: The use of direct-fed microorganisms (DFM) is an important alternative to antibiotic growth promoters (AGP) for improving growth and managing disease in poultry production. We investigated the administration of 2 multistrain Bacillus cultures administered as DFM on growth performance and mortality of broiler chickens reared under performance-reducing stress challenge. The first experiment evaluated the dose response of the growth of broiler chickens to the administration of 3 increasing concentrations of direct-fed Bacillus culture A (DFM A). Administration of the low dose of DFM A improved starter, grower, and cumulative FCR of broiler chickens as compared with an untreated control with no further benefit being observed at higher doses. The second experiment compared the administration of the low dose of DFM A with a second multistrain direct-fed Bacillus culture (DFM B) administered at a dose demonstrated previously to improve growth at a level similar to an AGP. The overall elevated level of mortality observed in this experiment was reduced by DFM A administration when compared with an untreated control over the grower phase and cumulatively. Additionally, when compared with an untreated control, DFM A administration reduced starter FCR, whereas DFM B administration reduced grower FCR. Overall, the results of our study suggest administration of multistrain Bacillus spp. cultures as DFM may be used as a potentially important alternative to AGP for improving growth and managing disease in poultry production.

The development of interventions to reduce human foodborne pathogens in the gastrointestinal (GI) tract of chickens will be important for improving the microbial food safety of poultry. Saccharomyces-derived prebiotic refined functional carbohydrates (RFC), composed primarily of β-glucans, mannanoligosaccharides (MOS), and D-mannose have been demonstrated to reduce GI colonization of Salmonella and Campylobacter when administered to poultry. Although they are presumed to inhibit adhesion of pathogens to the GI epithelium, this functionality of RFC has not been well characterized. In this study, we investigated the effects of RFC and other prebiotics on the adhesion of Salmonella Typhimurium and Campylobacter jejuni to the LMH chicken epithelial cell line in vitro. The reduction of adherent pathogens was observed to be dose-dependent with C. jejuni being more sensitive than Salmonella to inhibition by RFC. Comparison of the primary constituent carbohydrates of RFC found D-mannose to inhibit both pathogens less effectively than β-glucan and MOS, suggesting that it contributes less to inhibition of pathogen adhesion than the other carbohydrates. Finally, the reduction of adherent pathogens by RFC was compared with that of fructooligosaccharides (FOS), galactooligosaccharides (GOS), and raffinose. All 4 prebiotics inhibited adhesion of both pathogens to chicken epithelial cells. Reduction of adherent Salmonella was greatest with FOS and lowest with GOS, whereas reduction of adherent C. jejuni was greater with RFC and raffinose than with FOS and GOS. These results will inform future research elucidating mechanisms important to adhesion inhibition of pathogens by RFC and other prebiotics.

Summary: Due to regulation and consumer-driven decreases in the use of antibiotics, there is a critical need for the development of alternatives to antibiotic growth promoters (AGP) for use in poultry production. Direct-fed microorganisms (DFM) and prebiotics, which have been demonstrated to improve growth performance and microbial safety of poultry, are thought to be potentially important alternatives to AGP. In this study, we investigated the administration of 2 multi-strain Bacillus spp. cultures as DFM, Saccharomyces cerevisiae–derived refined functional carbohydrates (RFC) as a prebiotic, and a multi-strain direct-fed Bacillus spp. culture and RFC in combination as a synbiotic in comparison to an AGP and an untreated control in broiler chickens. DFM, prebiotic, and synbiotic administration improved BW at 14 D, starter FCR, and cumulative ADG when compared to an untreated control and at a level similar to broilers administered an AGP. Administration of either DFM culture, RFC, or the synbiotic reduced recovery of Campylobacter spp. by up to 1 log10 cfu g-1 when compared to the untreated control, whereas 1 log10 cfu g-1 more total Lactic Acid Bacteria were recovered when broilers were administered prebiotic RFC compared to the untreated control. These data suggest that administration of DFM and prebiotics can be used to improve growth performance, reduce the colonization of human foodborne pathogens, and promote populations of beneficial bacteria in poultry.

Summary: The objective of this study was to evaluate the effect of digestible essential AA density (dEAA) on the performance and processing yield of straight-run Cobb 700 × MV broilers. Broilers were fed a control diet based on the breeder's nutrient recommendations or one of 4 treatments consisting of 5% incremental increases in dEAA density over the control (+5, +10, +15, and +20% dEAA). The digestible lysine content of the control diets was 1.18, 1.07, 0.96, and 0.89% during the starter (0–12 D), grower (12–26 D), finisher (26–36 D), and withdrawal (36–49 D) diets, respectively. Broilers fed the increased dEAA were heavier at 12, 26, and 36 D as compared with those fed the control, and cumulative feed conversion ratio (0–49 D) was decreased by 6 and 8 points when dEAA was increased over the control diet by +10 and +15%, respectively. A 5.75% increase in boneless–skinless breast yield as compared with the control diet was observed when broilers were fed the +20% dEAA diet. A 4.6% increase in tenderloin yield was observed when broilers were fed the +10% dEAA diet, but no further increase was observed with the +15 or +20% dEAA diets. Fat pad yield was observed to decrease from 1.56 to 1.11% as dEAA increased from the control diet to the +20% dEAA diet, respectively. Overall, the improvements to growth performance and processing yields observed in this study support the feeding of increased dEAA diets to Cobb 700 × MV broilers.

Summary: The overall cost of feed is influenced largely by the nutritional requirements that are specified in its formulation and the ingredients that are used to meet those nutrient specifications. To meet the demand for breast meat and further processed products, heavy broiler chickens are grown to body weights exceeding 3.5 kg. In this study, we evaluated the effects of altering AA density and AME content of the diets over the last 3 feeding phases (grower: 12–26 D, finisher: 26–36 D, and withdrawal: 36–49 D) on the growth performance and processing yield of mixed-sex Cobb 700 × MV broilers. Broilers were fed a common starter diet followed by a 3 × 2 factorial arrangement of diets with 3 levels of AA density (low, medium, and high) and 2 levels of energy (low and high) beginning with the grower period. Broilers fed the high AA diet were heavier as compared with those fed the low AA diet, and FCR was observed to decrease incrementally when AA density and energy level were increased independently. Skinless-boneless breast yield increased incrementally with AA density, whereas fat pad yield increased as AA density of the diet decreased. Overall, our results demonstrate that the performance and meat yield of mixed-sex Cobb 700 × MV broilers responded positively to a higher density of AA and energy.

Teachers' racial biases can impact disparities in their perceptions and expectations of students and contribute to inequitable student outcomes. Therefore, interventions that train teachers on strategies for reducing racial biases may hold promise for mitigating inequities. However, research on bias-reduction interventions in applied contexts is limited and has not focused on examining the implementation of specific strategies or the implementation context. In this study, we used mixed methodology to examine the extent to which teachers (n = 43) use four bias-reduction strategies, called equity levers (i.e., seeking commonalities, gaining perspective, gathering facts to disprove assumptions, and knowing your vulnerabilities), which are embedded into a student-teacher relationship intervention called Equity-Explicit Establish-Maintain-Restore. In addition, we explored whether any features of the school context support or hinder their implementation of these strategies. We found that teachers implemented the four equity levers and reported increased implementation of these strategies over time. We found quantitative and qualitative evidence of the importance of a strong implementation climate for supporting teachers' use of the equity levers, where teachers collectively value implementing the program and collaborating with one another. This study has implications for both the promise of four specific strategies that can be incorporated into other teacher training to reduce racial bias as well as the importance of establishing strong contextual supports to ensure the successful implementation of equity-focused strategies.

SUMMARY: Direct-Fed Microorganisms (DFM) and exogenous enzymes have been demonstrated to improve growth performance in poultry and are potentially important components of management programs for antibiotic-free (ABF) poultry production. In this study, we evaluated the effect of a feed additive composed of a DFM product containing spores of 3 Bacillus amyloliquefaciens strains and a multi-enzyme complex of xylanase, amylase, and protease on the performance of broilers with or without an antibiotic growth promoter (AGP), either bacitracin methylene disalicylate (BMD) or virginiamycin. Growth performance of broilers fed one of 6 treatments arranged in a 3 (AGP) × 2 (additive) factorial was evaluated over a 42 d production period. Overall, administration of the feed additive improved body weight, body weight gain, and feed conversion ratio. Administration of either antibiotic significantly reduced cumulative FCR when compared to the control, while BMD administration reduced foot pad lesions as compared to the control. Our results suggest the co-administration of DFM and enzymes may be an important component of ABF poultry production programs and the benefits of their use are not dependent on the presence or absence of AGP.

SUMMARY: Coccidia have typically been controlled using anticoccidial drugs, while the use of vaccines has increased due to concerns over the development of drug resistance in Eimeria spp. Because they contain drug-sensitive Eimeria, vaccination has received interest as a potential intervention for managing drug resistance. Vaccines can also be used in conjunction with anticoccidial drugs as part of a bio-shuttle program in which vaccination of broilers on day of hatch is followed by the administration of an ionophore in-feed starting at approximately 16 to 18 d post-hatch. Although they have been demonstrated to mitigate Eimeria vaccine-related performance losses, very little research on the effects of bio-shuttle programs on growth performance, pathology, and Eimeria populations has been published. In this study, we developed a longitudinal profile of the response of commercial broiler chickens before, during, and after bio-shuttle application as part of the broader drug and vaccine program of a commercial integrator over a 12-month period. Evaluation of production data collected from a commercial integrator found that, overall, growth performance and intestinal Eimeria pathology to be worst during the bio-shuttle administration period and best during the period after bio-shuttle administration. The correspondence between growth performance and pathology suggests that the development of drug-resistant Eimeria populations may have been reduced or delayed by bio-shuttle application. The results of our study are expected to inform future research evaluating the effects of bio-shuttle administration in poultry production.

SUMMARY: Direct-Fed Microorganisms (DFM) are potentially important alternatives to antibiotic growth promoters (AGP). We investigated the administration of Bacillus subtilis administration as a DFM in broiler chickens. Comparison of DFM and AGP administration determined the DFM improved BW, BWG, ADFI, and carcass yield with compared to broilers fed an untreated diet and to those administered an AGP. Evaluation of DFM administration in broilers fed low and high distiller's dried grains with solubles (DDGS) diets determined starter and cumulative FCR of broiler fed a high DDGS diet was greater than those fed a low DDGS diet, while DFM administration improved FCR during the starter phase, days 0–28, and days 0–42 as compared to the untreated diet. Additionally, a DDGS × DFM interaction was observed on days 0–28 FCR. Although they were not significant, differences in FCR between untreated and DFM-treated broilers tended to be greater with high DDGS diets than with low DDGS diets. Overall, our results suggest that administration of B. subtilis as a DFM may potentially be used as an alternative to AGP and FCR improvements may be greater when broilers are fed high-DDGS diets compared to broilers fed low-DGGS diets.

Summary: Administration of functional feed additives, including direct-fed microorganisms (DFM), dietary prebiotics, and phytogenic preparations, has been demonstrated to improve growth performance, animal health, and microbial food safety in poultry and is thought to be a potentially important component of antibiotic-free poultry production. In this study, we investigated the administration of Bacillus licheniformis (BL) as a DFM, coadministration of BL with an additive blend of a dietary prebiotic and a phytogenic preparation (BL + A), and coadministration of BL with a dietary prebiotic as a synbiotic in broiler chickens in comparison with an antibiotic over a 21 d growth period. Administration of BL improved FCR as compared with untreated broilers through 14 d after hatch. Administration of BL + A and synbiotic increased total Lactic Acid Bacteria and decreased Clostridium perfringens compared with the antibiotic-treated and untreated broilers, respectively. Administration of BL was also observed to increase the villus height to crypt depth ratio as compared with the untreated control. Overall, our results suggest coadministration of B. licheniformis as a DFM with other functional feed additives is able to improve feed efficiency, promote positive shifts in populations of gastrointestinal microbiota, and improve measures of gastrointestinal function.

This letter is motivated by an apparent paradox, in that some quaternary systems (particularly in the Ti–Zr–Al–C system) have been shown to exhibit M-site out-of-plane ordering, while prior work and calculations by the present authors suggest endothermic interactions between Zr and Ti. In this letter we provide a resolution to this issue and provide a more extended analysis on the out-of-plane and in-plane ordering in the M sites of quaternary MAX alloys. The results provide further insights to develop criteria to predict potential out-of-plane ordering tendencies in other MAX systems.fx1

The search for further control over the properties of MAX phases as well as the promise of discovering compounds with new functionalities has resulted in an increased interest in MAX solid solutions resulting from mixing in either the M, A, or X sublattices. The possibility of alloying MAX compounds not only enables finer tuning of their properties but can also be used to stabilize compounds that may otherwise be metastable in their pure state. In this letter, we present an ab initio-based investigation of the intrinsic alloying behavior in the A sublattice of Ti $ _2 $ (Al,A)C, Zr $ _2 $ (Al,A)C and Ti $ _3 $ (Al,A)C $ _2 $ MAX compounds.

Abstract Background Decellularized extracellular matrix (dECM) has been proposed as a useful source of biomimetic materials for regenerative medicine due to its biological properties that regulate cell behaviors. The present study aimed to investigate the influence of decellularized ECM derived from dental pulp stem cells (DPSCs) on gingival fibroblast (GF) cell behaviors. Cells were isolated from dental pulp and gingival tissues. ECM was derived from culturing dental pulp stem cells in growth medium supplemented with ascorbic acid. A bioinformatic database of the extracellular matrix was constructed using Metascape. GFs were reseeded onto dECM, and their adhesion, spreading, and organization were subsequently observed. The migration ability of the cells was determined using a scratch assay. Protein expression was evaluated using immunofluorescence staining. Results Type 1 collagen and fibronectin were detected on the ECM and dECM derived from DPSCs. Negative phalloidin and nuclei were noted in the dECM. The proteomic database revealed enrichment of several proteins involved in ECM organization, ECM–receptor interaction, and focal adhesion. Compared with those on the controls, the GFs on the dECM exhibited more organized stress fibers. Furthermore, cultured GFs on dECM exhibited significantly enhanced migration and proliferation abilities. Interestingly, GFs seeded on dECM showed upregulation of FN1, ITGB3, and CTNNB1 mRNA levels. Conclusions ECM derived from DSPCs generates a crucial microenvironment for regulating GF adhesion, migration and proliferation. Therefore, decellularized ECM from DPSCs could serve as a matrix for oral tissue repair.

This article presents a short-term longitudinal study examining bidirectional associations between academic achievement and positive peer regard among Asian American and Latinx adolescents. Specifically, our investigation distinguished between positive peer regard within and across different ethnic groups in a diverse school setting. Three hundred and thirty-five middle school students (52.8% girls; 65% Asian American, 35% Latinx; assessment at the first time point M[subscript age] = 12.27 years, SD = 0.71) were followed across two consecutive school years. Participants completed a peer-nomination inventory assessing multiple dimensions of positive peer regard (i.e., reciprocal friendship, social acceptance, and respect), and grades were obtained from school records. Academic achievement was predictive of prospective positive peer regard received from same-ethnic peers only for Asian American adolescents. In contrast, academic achievement predicted prospective positive peer regard received from cross-ethnic peers only for Latinx adolescents. These results suggest that academic achievement was linked to social gains with peers from different ethnic backgrounds for Asian American and Latinx students. The findings underscore the importance of disentangling the sources of positive peer regard in multiethnic school environments.

5G-based MANET has received a lot of attention recently. Its fundamental feature is that nodes are constantly subjected to high traffic loads, while QoS requirements are extremely stringent. When applied to 5G-based MANETs, existing routing protocols have shown drawbacks. In this paper, we propose an enhanced AODV protocol solution for 5G-based MANETs. Using reinforcement learning, each node updates a state information database of intermediate nodes along routes to destinations. This database is used by the routing algorithm to find guaranteed QoS routes. Our solution is highly efficient in terms of throughput, end-to-end delay, and SNR, according to the simulation results.

Abstract Phenotypic degeneration in Cordyceps militaris poses a significant concern for producers, yet the mechanisms underlying this phenomenon remain elusive. To address this concern, we isolated two strains that differ in their abilities to form fruiting bodies. Our observations revealed that the degenerated strain lost the capacity to develop fruiting bodies, exhibited limited radial expansion, increased spore density, and elevated intracellular glycerol levels. Transcriptome reanalysis uncovered dysregulation of genes involved in the MAPK signaling pathway in the degenerate strain. Our RT-qPCR results demonstrated reduced expression of sexual development genes, along with upregulation of genes involved in asexual sporulation, glycerol synthesis, and MAPK regulation, when compared to the wild-type strain. Additionally, we discovered that osmotic stress reduced radial growth but increased conidia sporulation and glycerol accumulation in all strains. Furthermore, hyperosmotic stress inhibited fruiting body formation in all neutralized strains. These findings indicate dysregulation of the MAPK signaling pathway, the possibility of the activation of the high-osmolarity glycerol and spore formation modules, as well as the downregulation of the pheromone response and filamentous growth cascades in the degenerate strain. Overall, our study sheds light on the mechanisms underlying Cordyceps militaris degeneration and identifies potential targets for improving cultivation practices.

This paper proposes an isolated DC-DC converter to cope with 800 V input voltage and 48 V output voltage conditions of the auxiliary power module in the next generation 800 V electric vehicles. On the primary side, a split-capacitor structure and a series capacitor are utilized while on the secondary side, a current doubler rectifier is designed, which repeats a part of the primary structure. Compared with existing isolated converters, the proposed converter has attractive characteristics: 1) a double step-down ratio; 2) the voltage stress on all primary switches and primary transformer are reduced to half of the input voltage; 3) the power switches have soft-switching capability by ZVS characteristic in the primary side, ZV-ZCS in secondary side; 4) the soft-switching range is wide, which maintained even at light-load conditions. 5) allow reuse conventional devices of 400 V system in the updated 800 V system. These characteristics are achieved with a simple control strategy by the pulse width modulation method for switches on the primary side and only repeating primary gating signals for switches on the secondary side. In this paper, the operation and performance of the proposed converter are presented. Besides, an experiment at 800 V input, 48 V–1.2 kW output is also completed to validate the operation and effectiveness of the proposed converter.

During population-based HIV impact assessments (PHIAs), some participants who self-reported testing HIV-positive (PSRP) tested negative in one or more subsequent survey HIV tests. These unexpected discrepancies between their self-reported results and the survey results draw into question the validity of either the self-reported status or the test results. We analyzed PSRP with negative test results aged 15–59 years old using data collected from 2015 to 2021 in 13 countries, assessing prevalence, self-report status, survey HIV status, viral load, rapid tests and confirmatory tests, and answers to follow-up questions (such as years on treatment). Across these surveys, 19,026 participants were PSRP, and 256 (1.3%) of these were concluded to be HIV-negative after additional survey-based testing and review. PSRP determined to be HIV-negative trended higher in countries with a higher HIV prevalence, but their number was small enough that accepting self-reported HIV-positive status without testing would not have significantly affected the prevalence estimates for HIV or viral load suppression. Additionally, using more detailed information for Uganda, we examined 107 PSRP with any negative test results and found no significant correlation with years on treatment or age. Using these details, we examined support for the possible reasons for these discrepancies beyond misdiagnosis and false reporting. These findings suggest that those conducting surveys would benefit from a nuanced understanding of HIV testing among PSRP to conduct surveys ethically and produce high-quality results.

Router nodes placement (RNP) is an important issue in the design and implementation of wireless mesh networks (WMN). This is known as an P-hard problem, which cannot be solved using conventional algorithms. Consequently, approximate optimization strategies are commonly used to solve this problem. With heavy node density and wide-area WMNs, solving the RNP problem using approximation algorithms often faces many difficulties, therefore, a more effective solution is necessary. This motivated us to conduct this work. We propose a new method for solving the RNP problem using reinforcement learning (RL). The RNP problem is modeled as an RL model with environment, agent, action, and reward are equivalent to the network system, routers, coordinate adjustment, and connectivity of the RNP problem, respectively. To the best of our knowledge, this is the first study that applies RL to solve the RNP problem. The experimental results showed that the proposed method increased the network connectivity by up to 22.73% compared to the most recent methods.

Student-teacher relationships are critical to ensuring successful transitions to high school, but programs focused on building strong relationships have been concentrated at younger school levels. Therefore, the purpose of this study was to gather feedback from ninth grade students, teachers/staff, and administrators regarding an existing student-teacher relationship intervention, Establish-Maintain-Restore (EMR), to inform a "scaling-out" adaptation of EMR for high schools. Data were collected from 7 administrators, 8 teachers/staff, and 10 ninth-grade students from diverse ethnic/racial backgrounds. Participants quantitatively rated the acceptability and effectiveness of EMR strategy for the high school context and then described their rationale for their ratings in focus groups. ANOVAs were used to examine differences in appropriateness and effectiveness of EMR strategies across participant groups. We then used content analysis to explore identified problems and recommendations regarding discrepant strategies. We discuss implications for relationships at the high school level and for scaling-out interventions to novel developmental contexts.

A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics.

ABSTRACT Population-based HIV Impact Assessments (PHIAs) are national household (HH) surveys that provide HIV diagnosis and CD4 testing with an immediate return of results. Accurate CD4 results improve HIV-positive participants’ clinical care and inform the effectiveness of HIV programs. Here, we present CD4 results from the PHIA surveys that were conducted in 11 countries in sub-Saharan Africa between 2015 and 2018. All of the HIV-positive participants and 2 to 5% of the HIV-negative participants were offered Pima CD4 (Abbott, IL, USA) point-of-care (POC) tests. The quality of the CD4 test was ensured by conducting instrument verification, comprehensive training, quality control, a review of testing errors and an analysis of unweighted CD4 data by HIV status, age, gender, and antiretroviral (ARV) treatment status. Overall, CD4 testing was completed for 23,085 (99.5%) of the 23,209 HIV-positive and 7,329 (2.7%) of the 270,741 negative participants in 11 surveys. The instrument error rate was 11.3% (range, 4.4% to 15.7%). The median CD4 values among HIV-positive and HIV-negative participants (aged 15+) were 468 cells/mm3 (interquartile range [IQR], 307 to 654) and 811 cells/mm3 (IQR, 647 to 1,013), respectively. Among the HIV-positive participants (aged 15+), those with detectable ARVs had higher CD4 values (508 cells/mm3) than those with undetectable ARVs (385.5 cells/mm3). Among the HIV-positive participants (aged 15+), 11.4% (2,528/22,253) had a CD4 value of less than 200 cells/mm3, and approximately half of them (1,225/2,528 = 48.5%) had detectable ARVs, whereas 51.5% (1,303/2,528) had no detectable ARVs (P < 0.0001). We successfully implemented high quality POC CD4 testing using Pima instruments. Our data come from nationally representative surveys in 11 countries and provide unique insights regarding the CD4 distribution among HIV-positive individuals as well as the baseline CD4 values among HIV-negative individuals. IMPORTANCE The manuscript describes CD4 levels among HIV-positive individuals and baseline CD4 levels among HIV-negative individuals from 11 sub-Saharan countries, thereby highlighting the importance of CD4 markers in the context of the HIV epidemic. Despite increased ARV access in each country, advanced HIV disease (CD4

Background Extremes in perioperative blood pressures are known risk factors for adverse outcomes after surgical interventions. There is scarce literature studying these parameters as predictors of outcomes after ocular surgery.Methods This was a retrospective single-centre interventional cohort analysis to evaluate the relationship between perioperative (preoperative and intraoperative) blood pressure value and variability and postoperative visual and anatomic outcomes. Included were patients who underwent primary 27-gauge (27g) vitrectomy for repair of diabetic tractional retinal detachment (DM-TRD) with at least 6 months of follow-up. Univariate analyses were conducted via independent two-sided t-tests and Pearson’s χ2 tests. Multivariate analyses were conducted via generalised estimating equations.Results 71 eyes of 57 patients were included in the study. Higher preprocedure mean arterial pressure (MAP) was associated with fewer Snellen lines of improvement at postoperative month 6 (POM6) (p0.10).Conclusions Higher average perioperative blood pressure and blood pressure variability are associated with worse visual outcomes in patients undergoing 27g vitrectomy for DM-TRD repair. Patients with sustained intraoperative hypertension were approximately twice as likely to have visual acuity 20/200 or worse at POM6 compared to those without sustained intraoperative hypertension.

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