Using Electronic Drug Monitor Feedback to Improve Adherence to Antiretroviral Therapy Among HIV-Positive Patients in China

Effective antiretroviral therapy (ART) requires excellent adherence. Little is known about how to improve ART adherence in many HIV/AIDS-affected countries, including China. We therefore assessed an adherence intervention among HIV-positive patients in southwestern China. Eighty subjects were enrolled and monitored for 6 months. Sixty-eight remaining subjects were randomized to intervention/control arms. In months 7–12, intervention subjects were counseled using EDM feedback; controls continued with standard of care. Among randomized subjects, mean adherence and CD4 count were 86.8 vs. 83.8% and 297 vs. 357 cells/μl in intervention vs. control subjects, respectively. At month 12, among 64 subjects who completed the trial, mean adherence had risen significantly among intervention subjects to 96.5% but remained unchanged in controls. Mean CD4 count rose by 90 cells/μl and declined by 9 cells/μl among intervention and control subjects, respectively. EDM feedback as a counseling tool appears promising for management of HIV and other chronic diseases.Boston University and the Office of Health and Nutrition of the United States Agency for International Development (GHS-A-00-03-00030-00); World Health Organization; United States Centers for Disease Control; National Institutes of Health, National Institute of Allergy and Infectious Diseases (K23 AI 62208); Mid-Career Mentoring Award (K24 RR020300

The 8Li Calibration Source for the Sudbury Neutrino Obervatory

A calibration source employing 8Li (t_1/2 = 0.838s) has been developed for use with the Sudbury Neutrino Observatory (SNO). This source creates a spectrum of beta particles with an energy range similar to that of the SNO 8B solar neutrino signal. The source is used to test the SNO detector's energy response, position reconstruction and data reduction algorithms. The 8Li isotope is created using a deuterium-tritium neutron generator in conjunction with a 11B target, and is carried to a decay chamber using a gas/aerosol transport system. The decay chamber detects prompt alpha particles by gas scintillation in coincidence with the beta particles which exit through a thin stainless steel wall. A description is given of the production, transport, and tagging techniques along with a discussion of the performance and application of the source.Comment: 11 pages plus 9 figures, Sumbitted to Nuclear Instruments and Methods

Ground state parameters, finite-size scaling, and low-temperature properties of the two-dimensional S=1/2 XY model

We present high-precision quantum Monte Carlo results for the S=1/2 XY model on a two-dimensional square lattice, in the ground state as well as at finite temperature. The energy, the spin stiffness, the magnetization, and the susceptibility are calculated and extrapolated to the thermodynamic limit. For the ground state, we test a variety of finite-size scaling predictions of effective Lagrangian theory and find good agreement and consistency between the finite-size corrections for different quantities. The low-temperature behavior of the susceptibility and the internal energy is also in good agreement with theoretical predictions.Comment: 6 pages, 8 figure

Sedentary behaviour among elite professional footballers: Health and performance implications

Background: Elite athletes should have little concern about meeting recommended guidelines on physical activity. However, sedentary behaviour is considered a health risk independent of physical activity, and is recognised in public health guidelines advising against prolonged sedentary time. There has been very little research on athletes’ physical activity behaviour outside elite sport. Methods: Given health and performance links, we investigated in-season post-training activity levels in 28 elite professional footballers during the English Premiership season. Players volunteered to wear a triaxial wrist accelerometer for 1 week, removing it only for training and matches. In total, 25 players met the inclusion criteria for analysis. Players recorded on average 632.6 min wear time p/day during the post-training period (SD±52.9) for a mean of 3.8 days (SD±1.5). Results: On average, players recorded 76.2 min p/day (SD±28.8) of moderate or vigorous activity post-training. The majority (79%) of post-training time was spent in sedentary activities (500.6 min per day±59.0). Conclusions: Professional footballers are alarmingly sedentary in their leisure time, and comparatively more so than non-athletic groups of a similar age and older. This raises questions over optimum recovery and performance, as well as long-term health and cardiovascular risk. Worryingly, retirement from elite sport is likely to further imbalance activity and sedentary behaviour. Promoting regular periodic light to moderate leisure time activity could be beneficial. Further research and provision of education and support for players is required in this area

Travelers’ diarrhea and other gastrointestinal symptoms among Boston-area international travelers

INTRODUCTION: Travelers' diarrhea (TD) and non-TD gastrointestinal (GI) symptoms are common among international travelers. In a study of short-term travelers from Switzerland to developing countries, the most common symptom experienced was severe diarrhea (8.5%) followed by vomiting or abdominal cramps (4%).1 GI illnesses were the most frequently reported diagnoses (34%) among ill-returned travelers to GeoSentinel clinics.2 Of those returning to U.S. GeoSentinel clinics, acute diarrhea (30%) was the most common diagnosis.3 In one cohort of U.S. travelers, 46% reported diarrhea.4 GI illnesses can last from 2 days to weeks or longer,5 disrupting plans during travel or after returning home. Eighty percent of those who experienced diarrhea during travel treated themselves with medication and 6% sought medical care. METHODS: The Boston Area Travel Medicine Network (BATMN) is a research collaboration of travel clinics in the greater Boston area representing urban-, suburban-, academic-, and university-affiliated facilities. A convenience sample of travelers ≥ 18 years of age attending three BATMN clinics between 2009 and 2011 for pre-travel consultations completed pre-travel surveys, at least one survey weekly during travel, and a post-travel survey 2–4 weeks after return. Travelers were asked to complete a survey at the end of each week of their trip. Institutional review board approvals were obtained at all sites and the Centers for Disease Control and Prevention, and participants provided written informed consent. Information collected included demographic and trip characteristics, vaccines and medications recommended/prescribed before travel, medications taken during travel, dietary practices during travel (consumption of tap water, ice in drinks, unpasteurized dairy products, and salads), symptoms experienced, and impact of illness during and after travel. Vaccinations, prescriptions, and travel health advice given during the pre-travel consultation were recorded by a clinician, and the remainder of the surveys were completed by the traveler. Data were entered into a password-protected database (CS Pro, U.S. Census Bureau, Washington, DC). RESULTS: We enrolled 987 travelers; 628 (64%) completed all three parts (pre-, during, and post-travel) and were included in the study. Comparison of the 628 to the 359 who did not complete all three parts (noncompleters) revealed no differences, except that completion rates were higher for white travelers than all other racial/ethnic groups (P < 0.001) and for older travelers (median age 47 years versus 32 years in noncompleters, P < 0.001).11 Of those 628 travelers, 208 (33%) experienced TD, 45 (7%) experienced non-TD GI symptoms, 147 (23%) experienced non-GI symptoms, and 228 (36%) did not experience any symptoms during or after travel. Of the 208 with TD, 140 (67%) reported diarrhea as their only symptom, whereas 33 (16%) also experienced nausea/vomiting, 23 (11%) abdominal pain, and 27 (13%) fever (Table 1). Of the 45 who reported non-TD GI symptoms, 21 (47%) experienced nausea/vomiting, 19 (42%) experienced constipation, and 10 (22%) experienced abdominal pain during or after travel (Table 2). Almost all travelers (99%) received advice about food and water precautions and diarrhea management during pre-travel consultation

Finite-size correction and bulk hole-excitations for special case of an open XXZ chain with nondiagonal boundary terms at roots of unity

Using our solution for the open spin-1/2 XXZ quantum spin chain with N spins and two arbitrary boundary parameters at roots of unity, the central charge and the conformal dimensions for bulk hole excitations are derived from the 1/N correction to the energy (Casimir energy).Comment: 21 pages, LaTeX, v2: minor changes and 3 references adde

Direct Calculation of the Spin Stiffness in the J1J_1--J2J_2 Heisenberg Antiferromagnet

We calculate the spin stiffness $\rho_s$ for the frustrated spin-$\frac{1}{2}$ Heisenberg antiferromagnet on a square lattice by exact diagonalizations on finite clusters of up to $36$ sites followed by extrapolations to the thermodynamic limit. For the non-frustrated case, we find that $\rho_s = (0.183\pm 0.003)J_1$, in excellent agreement with the best results obtained by other means. Turning on frustration, the extrapolated stiffness vanishes for $0.4 \lesssim J_2/J_1 \lesssim 0.6$. In this intermediate region, the finite-size scaling works poorly -- an additional sign that their is neither N\'eel nor collinear magnetic order. Using a hydrodynamic relation, and previous results for the transverse susceptibility, we also estimate the spin-wave velocity in the N\'eel-ordered region.Comment: 4 pages, uuencoded compressed ps-file (made with uufiles

Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial

In a cluster randomized trial, Kojo Yeboah-Antwi and colleagues find that integrated management of malaria and pneumonia in children under five by community health workers is both feasible and effective. BACKGROUND. Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs). METHODS AND FINDINGS. Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14–0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19–8.94). There were two deaths in the intervention and one in the control arm. CONCLUSIONS. The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia.United States Agency for International Development (GHSA-00-00020-00) with Boston University; President's Malaria Initiativ

Finite-Temperature Scaling of Magnetic Susceptibility and Geometric Phase in the XY Spin Chain

We study the magnetic susceptibility of 1D quantum XY model, and show that when the temperature approaches zero, the magnetic susceptibility exhibits the finite-temperature scaling behavior. This scaling behavior of the magnetic susceptibility in 1D quantum XY model, due to the quantum-classical mapping, can be easily experimentally tested. Furthermore, the universality in the critical properties of the magnetic susceptibility in quantum XY model is verified. Our study also reveals the close relation between the magnetic susceptibility and the geometric phase in some spin systems, where the quantum phase transitions are driven by an external magnetic field.Comment: 6 pages, 4 figures, get accepted for publication by J. Phys. A: Math. Theo