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UNAIDS established fast-track targets of 73% and 86% viral suppression among human immunodeficiency virus (HIV)-positive individuals by 2020 and 2030, respectively. The epidemiologic impact of achieving these goals is unknown. The HIV-Calibrated Dynamic Model, a calibrated agent-based model of HIV transmission, is used to examine scenarios of incremental improvements to the testing and antiretroviral therapy (ART) continuum in South Africa in 2015. The speed of intervention availability is explored, comparing policies for their predicted effects on incidence, prevalence and achievement of fast-track targets in 2020 and 2030. Moderate (30%) improvements in the continuum will not achieve 2020 or 2030 targets and have modest impacts on incidence and prevalence. Improving the continuum by 80% and increasing availability reduces incidence from 2.54 to 0.80 per 100 person-years (−1.73, interquartile range (IQR): −1.42, −2.13) and prevalence from 26.0 to 24.6% (−1.4 percentage points, IQR: −0.88, −1.92) from 2015 to 2030 and achieves fast track targets in 2020 and 2030. Achieving 90-90-90 in South Africa is possible with large improvements to the testing and treatment continuum. The epidemiologic impact of these improvements depends on the balance between survival and transmission benefits of ART with the potential for incidence to remain high.
Traditionally health statistics are derived from civil and/or vital registration. Civil registration in low- to middle-income countries varies from partial coverage to essentially nothing at all. Consequently the state of the art for public health information in low- to middle-income countries is efforts to combine or triangulate data from different sources to produce a more complete picture across both time and space – data amalgamation. Data sources amenable to this approach include sample surveys, sample registration systems, health and demographic surveillance systems, administrative records, census records, health facility records and others. We propose a new statistical framework for gathering health and population data – Hyak – that leverages the benefits of sampling and longitudinal, prospective surveillance to create a cheap, accurate, sustainable monitoring platform. Hyak has three fundamental components:
•Data amalgamation: A sampling and surveillance component that organizes two or more data collection systems to work together: (1) data from HDSS with frequent, intense, linked, prospective follow-up and (2) data from sample surveys conducted in large areas surrounding the Health and Demographic Surveillance System (HDSS) sites using informed sampling so as to capture as many events as possible;
•Cause of death: Verbal autopsy to characterize the distribution of deaths by cause at the population level; and
•Socioeconomic status (SES): Measurement of SES in order to characterize poverty and wealth.
We conduct a simulation study of the informed sampling component of Hyak based on the Agincourt HDSS site in South Africa. Compared with traditional cluster sampling, Hyak's informed sampling captures more deaths, and when combined with an estimation model that includes spatial smoothing, produces estimates of both mortality counts and mortality rates that have lower variance and small bias.
Established methods of recruiting population controls for case–control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case–control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.
In just the last forty years, imprisonment has been transformed from an event experienced by only the most marginalized to a common stage in the life course of American men—especially Black men with low levels of educational attainment. Although much research considers the causes of the prison boom and how the massive uptick in imprisonment has shaped crime rates and the life course of the men who experience imprisonment, in recent years, researchers have gained a keen interest in the spillover effects of mass imprisonment on families, children, and neighborhoods. Unfortunately, although this new wave of research documents the generally harmful effects of having a family member or loved one incarcerated, it remains unclear how much the prison boom shapes social inequality through these spillover effects because we lack precise estimates of the racial inequality in connectedness—through friends, family, and neighbors—to prisoners. Using the 2006 General Social Survey, we fill this pressing research gap by providing national estimates of connectedness to prisoners—defined in this article as knowing someone who is currently imprisoned, having a family member who is currently imprisoned, having someone you trust who is currently imprisoned, or having someone you know from your neighborhood who is currently imprisoned—for Black and White men and women. Most provocatively, we show that 44% of Black women (and 32% of Black men) but only 12% of White women (and 6% of White men) have a family member imprisoned. This means that about one in four women in the United States currently has a family member in prison. Given these high rates of connectedness to prisoners and the vast racial inequality in them, it is likely that mass imprisonment has fundamentally reshaped inequality not only for the adult men for whom imprisonment has become common, but also for their friends and families.
Mindfulness-based cognitive therapy (MBCT) is a group-based intervention similar to mindfulness-based stress reduction, but which includes cognitive therapy techniques. This study investigates its usefulness in the treatment of depressive, anxiety and stress/distress symptoms in cancer patients referred to a psycho-oncology service. It also examines whether effect on depression is mediated by self-compassion.
In phase 1 of this study, 16 cancer patients with mild/moderate psychological distress were randomised to MBCT (n=8) or treatment as usual (TAU; n=8), and assessed pre- and post-treatment. Analysis of variance was performed to examine the effect of treatment on anxiety and depression. In phase 2, the TAU group received the intervention, and results of pre- and post-MBCT assessments were combined with those receiving MBCT in phase 1. Finally, both groups were followed up at 3 months.
In phase 1, the MBCT group had a significant improvement in mindfulness and a decrease in anxiety. Statistically significant improvements in both depression and anxiety were found at 3 month follow-up. Self-compassion appeared to mediate the effect on anxiety/depression.
This small pilot study suggests that MBCT may have a beneficial effect on psychological variables often adversely affected in cancer in a heterogeneous cancer population.
With the revolutions in Eastern Europe precipitating a radical transformation of the Cold War which has dominated East-West relations for the past half century, there is a need and an opportunity to examine anew the processes and structures of modern warfare. By constructing a model of the Cold War as an addictive system in which the Americans and the Soviets have cooperated as “nuclear” codependents in the addictive process of the arms race it may be possible to gain a more realistic (dynamic and systemic) understanding of the forces driving global militarism as well as some insights into the dangers which lie ahead as the United States attempts to withdraw and recover from this reality.
Understanding and celebrating the Eucharist does not take place in a vacuum, but depends at least in part on our ability to grasp and be moved by the fundamental symbols of food, body, and table. And yet in contemporary America we increasingly find ourselves in a culture characterized by distorted experiences and notions of all three of these. How, then, does our growing obsession with dieting, nutrition, and efficiency, as well as the increasing disparity of our national and global tables, challenge or undermine our experience of breaking, sharing, and eating the Body and Blood of Christ? And how does the Eucharist speak to and challenge some of the distortions of “Diet America” regarding the humanizing characteristics of food, the importance of embodiment, and the demands of table fellowship?
The episcopal silence and secrecy associated with the recent pedophilia scandal echoes a larger inability of the Catholic episcopal hierarchy to enter into open and honest dialogue about a wide range of sexual issues. For more than three decades the chasm between official teachings on sexuality and gender and the belief and/or practice of the majority of Catholic laity, clergy and theologians (and an unknown number of bishops) has been growing. Still, attempts to address or bridge this divide have met with a fourfold silence. It is a silence that has kept bishops from speaking their true minds, a silence sought by restricting, investigating and sanctioning theologians, a silence that renders pastors mute or covert on sexual matters, and a silence that ignores the experience and voices of women. Such a silence undermines magisterial authority and deprives Catholics of a useful and persuasive sexual ethic, while marginalizing those willing to speak out and demoralizing those who feel they cannot.
Many oppose the mandatum as a threat to the academic freedom of Catholic scholars and the autonomy and credibility of Catholic universities. But the imposition of this juridical bond on working theologians is also in tension with Catholic Social Teaching on the rights and dignity of labor. Work is the labor necessary to earn our daily bread. But it is also the vocation by which we realize ourselves as persons and the profession through which we contribute to the common good. Thus, along with the right to a just wage and safe working conditions, Catholic Social Teaching defends workers' rights to a full partnership in the enterprise, and calls upon the church to be a model of participation and cooperation. The imposition of the mandatum fails to live up to this standard and threatens the jobs and vocations of theologians while undermining this profession's contribution to the church.
By means of 29Si spectroscopy, it is established that the distribution of silicate anions in alkaline silicate solutions is a moderate function of base composition. At a fixed SiO2. concentration and silicate ratio, the proportion of Si present in oligomeric and cage-like structures increases in progressing from Li to Cs hydroxide. Interactions between alkali metal cations and silicate anions are investigated using NMR spectroscopy of the cations; in this way the concentration of ion pairs is measured as a function of cation size. As a result the silicate redistribution is ascribed to cation-silicate anion pairing and to a higher selectivity for ion pairing by large silicate anions as cation size increases.
The factors affecting the production of homogeneous aluminosilicate gels from alkoxide precursors were investigated. Aluminosilicate gels were made in acidic conditions with a prepolymerization of the silicate precursor followed by the addition of the alumina precursor.
Confirming earlier studies, we found that the gel homogeneity is increased when the rate of gelation decreases. The reduction of the water content and/or the aluminum precursor, and more surprisingly the increase of the acid concentration contributed to the gel time increase and thus the gel homogeneity improvement.
The condensation kinetics and the role of Ion pairing are investigated for silicate anions in alkaline solutions. Selective, and non-selective inversion recovery experiments are performed using the Si NMR spectrum of alkali metal silicate solutions. In this way the rates of condensation of silicate monomers is studied as a function of the nature of the base. These rates exhibit maxima with increasing cation size. The maxima are interpreted in terms of the concentration and activity of ion pair intermediates of the Si exchange reaction.
Interactions between alkali metal cations and larger silicate anions in silicate solutions are investigated using NMR spectroscopy of the cations. The chemical shift and the resonance llnewidths are used to estimate the concentration of cation-silicate ion pairs. The concentration of pairs involving large anions increases with increasing cation size. Thus it is expected that condensation kinetics are influenced by the size of the silicate fragment.
Samples of diamond crystals produced under various high pressure, high temperature conditions were studied using both micro photoluminescence and Raman spectroscopy. The 0.3 - 0.6 mm sized samples exhibited various levels of inclusion content, impurity content and strain. Photoluminescence studies revealed the presence of nitrogen in three forms. The 1.945 eV, 2.15 eV and 2.46 eV zero phonon lines and their associated sidebands were detected. The ratios between forms of impurities and their integrated intensities varied between samples. Variations in the distribution of the nitrogen forms were seen between regions of high and low strain birefringence patterns.
Investigation of the interactions in two magnetic composite systems composed of ∼8 vol% isolated Sm2Co17 nanoparticles of different size ranges in a CaO matrix has been made by comparing the isothermal remanent magnetization curves (IRM) with the dc demagnetization curves (DCD) using Wohlfarth remanence relation. The presence of a weak demagnetizing field was evidenced in the sample with smaller magnetic particles (7-90nm), indicating the magnetostatic interaction between the magnetic particles was dominant in this sample. The large positive deviation from Wolhfarth relation in the sample with larger particles (10-250nm) suggests the presence of multigrain particles in which neighboring grains interact strongly with each other. The hysteresis curves of the two composite systems were measured at temperatures between 5 and 350K. A nearly linear temperature dependence of the coercivity was observed in both samples up to 350 K. From these results it is shown that although the sizes of the Sm2Co17 particles are well below the critical size for single domain particle, there is no evidence that the magnetization reversals in these particles are coherent rotation.
Melt-quenched NdFeB is an important modem permanent magnet material. However there still remains doubt as to the magnetization reversal mechanism which controls coercivity in material prepared by this processing route. To investigate this problem a new technique based on measurements of reversible magnetization along recoil curves has been used. The technique identifies the presence of free domain walls during magnetic reversal. For this study samples of isotropic (MQI), hot pressed (MQII) and die upset (MQIII) melt-quenched NdFeB were examined. The results indicate that in MQI free domain walls are not present during reversal and the reversal mechanism is most likely incoherent rotation of some form. Free domain walls are also not present during reversal in the majority of grains of MQII, even though initial magnetization measurements indicate that the grain size is large enough to support them. In MQIII free domain walls are present during reversal. These results are attributed to the reduced domain wall nucleation field in MQII compared with MQII and the increased dipolar interactions in MQIII.
Hydrolytic polycondensation of silicon alkoxides and organically modified alkoxides shows promise as a route to new materials for medicine. Mathematical models of this polymerization accelerate the development of these materials and processes for their production. With a reliable model, one can rapidly explore a wide variety of options for controlling material properties. Here we describe a model for kinetics of sol-gel copolymerization of a simple pair of ethoxysilanes: (CH3)3Si(OC2H5) and (CH3)2Si(OC2H5)2. We then describe how reactor configuration alone can be used to control of polymer structure by choosing how to mix the reactants. An example is shown of maximizing homogeneity at any reactor residence time of interest in the model copolymer system by using the time of addition of the faster-reacting monomer.