Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.

OBJECTIVE: To investigate the impact of antiretroviral therapy (ART) on long-term population-level tuberculosis disease (TB) incidence in sub-Saharan Africa. METHODS: We used a mathematical model to consider the effect of different assumptions about life expectancy and TB risk during long-term ART under alternative scenarios for trends in population HIV incidence and ART coverage. RESULTS: All the scenarios we explored predicted that the widespread introduction of ART would initially reduce population-level TB incidence. However, many modelled scenarios projected a rebound in population-level TB incidence after around 20 years. This rebound was predicted to exceed the TB incidence present before ART scale-up if decreases in HIV incidence during the same period were not sufficiently rapid or if the protective effect of ART on TB was not sustained. Nevertheless, most scenarios predicted a reduction in the cumulative TB incidence when accompanied by a relative decline in HIV incidence of more than 10% each year. CONCLUSIONS: Despite short-term benefits of ART scale-up on population TB incidence in sub-Saharan Africa, longer-term projections raise the possibility of a rebound in TB incidence. This highlights the importance of sustaining good adherence and immunologic response to ART and, crucially, the need for effective HIV preventive interventions, including early widespread implementation of ART

Cleaved surface of i-AlPdMn quasicrystals: Influence of the local temperature elevation at the crack tip on the fracture surface roughness

Roughness of i-AlPdMn cleaved surfaces are presently analysed. From the atomic scale to 2-3 nm, they are shown to exhibit scaling properties hiding the cluster (0.45 nm) aperiodic structure. These properties are quantitatively similar to those observed on various disordered materials, albeit on other ranges of length scales. These properties are interpreted as the signature of damage mechanisms occurring within a 2-3 nm wide zone at the crack tip. The size of this process zone finds its origin in the local temperature elevation at the crack tip. For the very first time, this effect is reported to be responsible for a transition from a perfectly brittle behavior to a nanoductile one.Comment: 8 page

Six-Month Mortality among HIV-Infected Adults Presenting for Antiretroviral Therapy with Unexplained Weight Loss, Chronic Fever or Chronic Diarrhea in Malawi.

In sub-Saharan Africa, early mortality is high following initiation of antiretroviral therapy (ART). We investigated 6-month outcomes and factors associated with mortality in HIV-infected adults being assessed for ART initiation and presenting with weight loss, chronic fever or diarrhea, and with negative TB sputum microscopy

Effect of antiretroviral therapy on the diagnostic accuracy of symptom screening for intensified tuberculosis case finding in a South African HIV clinic.

BACKGROUND: Current symptom screening algorithms for intensified tuberculosis case finding or prior to isoniazid preventive therapy (IPT) in patients infected with human immunodeficiency virus (HIV) were derived from antiretroviral-naive cohorts. There is a need to validate screening algorithms in patients on antiretroviral therapy (ART). METHODS: We performed cross-sectional evaluation of the diagnostic accuracy of symptom screening, including the World Health Organization (WHO) algorithm, to rule out tuberculosis in HIV-infected individuals pre-ART and on ART undergoing screening prior to IPT. RESULTS: A total of 1429 participants, 54% on ART, had symptom screening and a sputum culture result available. Culture-positive tuberculosis was diagnosed in 126 patients (8.8%, 95% confidence interval [CI], 7.4%-10.4%). The WHO symptom screen in the on-ART compared with the pre-ART group had a lower sensitivity (23.8% vs 47.6%), but higher specificity (94.4% vs 79.8%). The effect of ART was independent of CD4(+) count in multivariable analyses. The posttest probability of tuberculosis following a negative WHO screen was 8.9% (95% CI, 7.4%-10.8%) and 4.4% (95% CI, 3.7%-5.2%) for the pre-ART and on-ART groups, respectively. Addition of body mass index to the WHO screen significantly improved discriminatory ability in both ART groups, which was further improved by adding CD4 count and ART duration. CONCLUSIONS: The WHO symptom screen has poor sensitivity, especially among patients on ART, in a clinic where regular tuberculosis screening is practiced. Consequently, a significant proportion of individuals with tuberculosis would inadvertently be placed on isoniazid monotherapy despite high negative predictive values. Until more sensitive methods of ruling out tuberculosis are established, it would be prudent to do a sputum culture prior to IPT where this is feasible

Dynamic instabilities of fracture under biaxial strain using a phase field model

We present a phase field model of the propagation of fracture under plane strain. This model, based on simple physical considerations, is able to accurately reproduce the different behavior of cracks (the principle of local symmetry, the Griffith and Irwin criteria, and mode-I branching). In addition, we test our model against recent experimental findings showing the presence of oscillating cracks under bi-axial load. Our model again reproduces well observed supercritical Hopf bifurcation, and is therefore the first simulation which does so

Dynamical stability of the crack front line

Dynamical stability of the crack front line that propagates between two plates is studied numerically using the simple two-dimensional mass-spring model. It is demonstrated that the straight front line is unstable for low speed while it becomes stable for high speed. For the uniform model, the roughness exponent in the slower speed region is fairly constant around 0.4 and there seems to be a rough-smooth transition at a certain speed. For the inhomogeneous case with quenched randomness, the transition is gradual.Comment: 14 pages, 7 figure

Imprinting the memory into paste and its visualization as crack patterns in drying process

In the drying process of paste, we can imprint into the paste the order how it should be broken in the future. That is, if we vibrate the paste before it is dried, it remembers the direction of the initial external vibration, and the morphology of resultant crack patterns is determined solely by the memory of the direction. The morphological phase diagram of crack patterns and the rheological measurement of the paste show that this memory effect is induced by the plasticity of paste.Comment: 4 pages, 3 figures, submitted to JPS

Crack fronts and damage in glass at the nanometer scale

We have studied the low speed fracture regime for different glassy materials with variable but controlled length scales of heterogeneity in a carefully mastered surrounding atmosphere. By using optical and atomic force microscopy (AFM) techniques we tracked in real-time the crack tip propagation at the nanometer scale on a wide velocity range (mm/s - pm/s and below). The influence of the heterogeneities on this velocity is presented and discussed. Our experiments reveal also -for the first time- that the crack progresses through nucleation, growth and coalescence of nanometric damage cavities within the amorphous phase. This may explain the large fluctuations observed in the crack tip velocities for the smallest values. This behaviour is very similar to what is involved, at the micrometric scale, in ductile fracture. The only difference is very likely due to the related length scales (nanometric instead of micrometric). Consequences of such a nano-ductile fracture mode observed at a temperature far below the glass transition temperature in glass is finally discussed.Comment: 12 pages, 8 figures, submitted to Journal of Physics: Condensed Matter; Invited talk at Glass and Optical Materials Division Fall 2002 Meeting, Pittsburgh, Pa, US