Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact

The permeability and selectivity of nanocomposite membrane of PEBAx 1657/PEI/SiO2 for separation of CO2, N2, O2, CH4 gases: A data set

The poly ether-block-amide (PEBAx)/Poly-ether-imide (PEI)/SiO2 nanocomposite membranes were fabricated using the solution casting method and utilized for separation of N2, O2, CH4, and CO2 gases. The effect of SiO2 nanoparticles loading on permeability and selectivity of gases using the nanocomposite membranes was tested. The data showed that the permeability of the gases increased with increasing SiO2 nanoparticle content. dBy adding SiO2 nanoparticles (10 wt%), the permeability of N2, O2, CH4, and CO2 gases elevated from 0.39, 1, 1.83 and 11.1 to 2.01, 1.95, 2.98 and 19.83 Barrer unit, respectively (at a pressure of 2 Bar). In contrast, with increasing SiO2 content the selectivity of the studied gases decreased. The morphology, crystallinity and the functional groups of the fabricated membranes were evaluated using scanning electron microscopy (SEM), X-ray diffraction (XRD) and Fourier-transform infrared spectroscopy (FTIR) techniques. The data presented confirm the influence of the nanoparticles on the membrane structure and thus on the permeability and selectivity of the membranes

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Atomic-Scale Structural Characterization of Silver-Doped Phosphate-Based Glasses Prepared by Coacervation

Phosphate-based glasses (PBGs) are traditionally prepared using the high temperature melt quenching route (MQ) or via the more recent sol-gel method (SG) that requires the use of organic solvents. The coacervation method represents an excellent inexpensive and green alternative to MQ and SG, being performed in aqueous solution and at room temperature. Coacervation is particularly applicable for the production of PBGs designed for biomedical applications, because it allows for the inclusion of temperature sensitive molecules and it does not require the use of toxic solvents. Whereas the atomic structure of the melt quenched and sol-gel PBGs is known, the atomic structure of those prepared via coacervation has yet to be investigated. In this study, a comprehensive advanced structural characterization has been performed on phosphate-based glasses in the system P2O5–CaO–Na2O–Ag2O (Ag2O mol% = 0, 1, 3, 5, 9 and 14) prepared via the coacervation method. Glasses within this system should find application as bioresorbable biomaterials thanks to their ability to release bioactive ions in a controlled manner. In particular, they possess antibacterial properties, inferred by the release of Ag+ over time. High energy X-ray diffraction (HEXRD), 31P and 23Na solid state magic angle spinning nuclear magnetic resonance (MAS NMR) and X-ray Absorption (XAS) at the Ag K-edge were used to probe the atomic structure of the glasses after drying in vacuum and after calcination at 300 °C. The length of the polyphosphate chains in the solid state appears to be independent of silver concentration, however, significant degradation of these chains is seen after calcination at 300 °C. Atomic-scale structure results indicate that the structure of these glasses is akin to that of other silver doped phosphate glasses prepared using the MQ and SG method. This suggests that phosphate-based glasses prepared using milder and greener conditions may have similar chemical and physical properties such as solubility, biocompatibility, and antibacterial properties

Waste sludge from shipping docks as a catalyst to remove amoxicillin in water with hydrogen peroxide and ultrasound

The waste sludge from shipping docks contains important elements that can be used as a catalyst after proper processing. The purpose of this study was to remove of amoxicillin (AMX) from the aquatic environment using waste sludge from shipping docks as catalyst in the presence of hydrogen peroxide/ultrasound waves. The catalyst was produced by treating waste sludge at 400 °C for 2 h. N2 adsorption, SEM, XRD, XRF, and FTIR techniques characterized the structural and physical properties of the catalyst. The BET-specific surface area of the catalyst reduced after AMX removal from 4.4 m2/g to 3.6 m2/g. To determine the optimal removal conditions, the parameters of the design of experiments were pH (5–9), contaminant concentration (5–100 mg/L), catalyst dosage (0.5–6 g/L), and concentration of hydrogen peroxide (10–100 mM). The maximum removal of AMX (98%) was obtained in the catalyst/hydrogen peroxide/ultrasound system at pH 5, catalyst dose of 4.5 g/L, H2O2 concentration of 50 mM, AMX concentration of 5 mg/L, and contact time of 60 min. The kinetics of removal of AMX from urine (k = 0.026 1/min), hospital wastewater (k = 0.021 1/min), and distilled water (k = 0.067 1/min) followed a first-order kinetic model (R2>0.91). The catalyst was reused up to 8 times and the AMX removal decreased to 45% in the last use. The byproducts and reaction pathway of AMX degradation were also investigated. The results clearly show that to achieve high pollutant removal rate the H2O2/ultrasound and catalyst/ultrasound synergy plays a key role

Air pollution perception in ten countries during the COVID-19 pandemic

As largely documented in the literature, the stark restrictions enforced worldwide in 2020 to curb the COVID-19 pandemic also curtailed the production of air pollutants to some extent. This study investigates the perception of the air pollution as assessed by individuals located in ten countries: Australia, Brazil, China, Ghana, India, Iran, Italy, Norway, South Africa and the USA. The perceptions towards air quality were evaluated by employing an online survey administered in May 2020. Participants (N = 9394) in the ten countries expressed their opinions according to a Likert-scale response. A reduction in pollutant concentration was clearly perceived, albeit to a different extent, by all populations. The survey participants located in India and Italy perceived the largest drop in the air pollution concentration; conversely, the smallest variation was perceived among Chinese and Norwegian respondents. Among all the demographic indicators considered, only gender proved to be statistically significant

Customized clinical practice guidelines for management of adult cataract in Iran

Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. Results: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. Conclusion: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients. © 2015 Journal of Ophthalmic and Vision Research | Published by Wolters Kluwer - Medknow

Drug treatments for covid-19: living systematic review and network meta-analysis

Abstract Objective To compare the effects of treatments for coronavirus disease 2019 (covid-19). Design Living systematic review and network meta-analysis. Data sources WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 1 March 2021 and six additional Chinese databases up to 20 February 2021. Studies identified as of 12 February 2021 were included in the analysis. Study selection Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles. Methods After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance. Results 196 trials enrolling 76 767 patients were included; 111 (56.6%) trials and 35 098 (45.72%) patients are new from the previous iteration; 113 (57.7%) trials evaluating treatments with at least 100 patients or 20 events met the threshold for inclusion in the analyses. Compared with standard care, corticosteroids probably reduce death (risk difference 20 fewer per 1000 patients, 95% credible interval 36 fewer to 3 fewer, moderate certainty), mechanical ventilation (25 fewer per 1000, 44 fewer to 1 fewer, moderate certainty), and increase the number of days free from mechanical ventilation (2.6 more, 0.3 more to 5.0 more, moderate certainty). Interleukin-6 inhibitors probably reduce mechanical ventilation (30 fewer per 1000, 46 fewer to 10 fewer, moderate certainty) and may reduce length of hospital stay (4.3 days fewer, 8.1 fewer to 0.5 fewer, low certainty), but whether or not they reduce mortality is uncertain (15 fewer per 1000, 30 fewer to 6 more, low certainty). Janus kinase inhibitors may reduce mortality (50 fewer per 1000, 84 fewer to no difference, low certainty), mechanical ventilation (46 fewer per 1000, 74 fewer to 5 fewer, low certainty), and duration of mechanical ventilation (3.8 days fewer, 7.5 fewer to 0.1 fewer, moderate certainty). The impact of remdesivir on mortality and most other outcomes is uncertain. The effects of ivermectin were rated as very low certainty for all critical outcomes, including mortality. In patients with non-severe disease, colchicine may reduce mortality (78 fewer per 1000, 110 fewer to 9 fewer, low certainty) and mechanical ventilation (57 fewer per 1000, 90 fewer to 3 more, low certainty). Azithromycin, hydroxychloroquine, lopinavir-ritonavir, and interferon-beta do not appear to reduce risk of death or have an effect on any other patient-important outcome. The certainty in effects for all other interventions was low or very low. Conclusion Corticosteroids and interleukin-6 inhibitors probably confer important benefits in patients with severe covid-19. Janus kinase inhibitors appear to have promising benefits, but certainty is low. Azithromycin, hydroxychloroquine, lopinavir-ritonavir, and interferon-beta do not appear to have any important benefits. Whether or not remdesivir, ivermectin, and other drugs confer any patient-important benefit remains uncertain. Systematic review registration This review was not registered. The protocol is publicly available in the supplementary material. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This is the fourth version of the original article published on 30 July 2020 ( BMJ 2020;370:m2980), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity. </jats:sec