Academic literature on the topic 'Universal Test and Treat strategy'

Background: Several cluster-randomized trials are underway to investigate the implementation and effectiveness of a universal test-and-treat strategy on the HIV epidemic in sub-Saharan Africa. We consider nesting studies of pre-exposure prophylaxis within these trials. Pre-exposure prophylaxis is a general strategy where high-risk HIV– persons take antiretrovirals daily to reduce their risk of infection from exposure to HIV. We address how to target pre-exposure prophylaxis to high-risk groups and how to maximize power to detect the individual and combined effects of universal test-and-treat and pre-exposure prophylaxis strategies. Methods: We simulated 1000 trials, each consisting of 32 villages with 200 individuals per village. At baseline, we randomized the universal test-and-treat strategy. Then, after 3 years of follow-up, we considered four strategies for targeting pre-exposure prophylaxis: (1) all HIV– individuals who self-identify as high risk, (2) all HIV– individuals who are identified by their HIV+ partner (serodiscordant couples), (3) highly connected HIV– individuals, and (4) the HIV– contacts of a newly diagnosed HIV+ individual (a ring-based strategy). We explored two possible trial designs, and all villages were followed for a total of 7 years. For each village in a trial, we used a stochastic block model to generate bipartite (male–female) networks and simulated an agent-based epidemic process on these networks. We estimated the individual and combined intervention effects with a novel targeted maximum likelihood estimator, which used cross-validation to data-adaptively select from a pre-specified library the candidate estimator that maximized the efficiency of the analysis. Results: The universal test-and-treat strategy reduced the 3-year cumulative HIV incidence by 4.0% on average. The impact of each pre-exposure prophylaxis strategy on the 4-year cumulative HIV incidence varied by the coverage of the universal test-and-treat strategy with lower coverage resulting in a larger impact of pre-exposure prophylaxis. Offering pre-exposure prophylaxis to serodiscordant couples resulted in the largest reductions in HIV incidence (2% reduction), and the ring-based strategy had little impact (0% reduction). The joint effect was larger than either individual effect with reductions in the 7-year incidence ranging from 4.5% to 8.8%. Targeted maximum likelihood estimation, data-adaptively adjusting for baseline covariates, substantially improved power over the unadjusted analysis, while maintaining nominal confidence interval coverage. Conclusion: Our simulation study suggests that nesting a pre-exposure prophylaxis study within an ongoing trial can lead to combined intervention effects greater than those of universal test-and-treat alone and can provide information about the efficacy of pre-exposure prophylaxis in the presence of high coverage of treatment for HIV+ persons.

Poor adherence was the major challenge in providing treatment, care, and support for people living with HIV (PLHIV). Evidence of adherence to antiretroviral therapy (ART) after initiation of the Universal Test and Treat (UTT) strategy was limited in Ethiopia. So, this study aimed to determine the proportion of ART adherence after the initiation of UTT strategy and associated factors among adult PLHIV in Dessie town using two adherence measurements. A cross-sectional study was conducted on 293 PLHIV selected using a systematic sampling technique. The data were collected by face-to face-interview using a pretested questionnaire; chart review was also used to collect the data. The proportion of ART adherence measured by using the Morisky scale and seven-day recall was 49.3% (95% CI: [43.5%, 54.8%]) and 95.9% (95% CI: [93.2%, 98.2%]), respectively. Being urban in residence (AOR = 3.72, 95% CI: [1.80, 7.68]), the absence of depression (adjusted odds ratio [AOR] = 3.72, 95% CI: [1.22, 11.35]), taking one tablet per day (AOR = 3.26, 95% CI: [1.64, 6.49]), and the absence of concomitant illness (AOR = 0.23, 95% CI: [0.09, 0.59]) were factors associated with ART adherence. The proportion of ART adherence measured by the Morisky scale was very low; however, adherence measured by seven-day recall was higher and consistent with World Health Organization recommendations. Residence, depression, and the number of tablets taken per day had a positive association with good ART adherence whereas having concomitant illness had a negative association with good ART adherence. Efforts should be made to improve adherence and interventions should be given to overcome factors linked with poor adherence.

Background: The South African government implemented the Universal Test and Treat (UTT) approach to treating HIV in the second half of 2016. As part of a contribution to the successful implementation of UTT, this study looked at barriers to implementation of UTT emanating from weaknesses of the health system in 2 Community Health Centers in South Africa’s Eastern Cape Province. Methods: This was a quantitative cross-sectional design which had both descriptive and analytical components. Convenience sampling was used to select and recruit 2 primary care facilities and 30 nurses. Self-administered questionnaires were used to solicit data from facility managers and nurses. In addition, a record review was used to access 6 months’ data for the period 1 October 2017 to 31 March 2018. Data were analyzed using Stata 14.1. Categorical data were presented using frequency and contingency tables. The 95% confidence interval (95% CI) is used for the precision of estimates and the P-value of statistical significance is P < .05. Results: Facilities were found to have poor leadership and governance; human resource challenges that include shortages, lack of skills and lack of developmental support; poorly resourced service delivery platforms and poor information management. Of the three 90-90-90 targets, health facilities only satisfactorily achieved the second 90 of initiating all who test positive for HIV within a week (93.1% or n = 288/307). Conclusions: This study has been able to identify potential barriers to the implementation of the UTT strategy at the selected facilities including the lack of structured programs in place to monitor performance of healthcare staff, knowledge gaps, and a lack of good clinical governance practices as evidenced by the lack of customized protocols and Standard Operating Procedures.

Purpose This updated provisional clinical opinion presents a revised opinion based on American Society of Clinical Oncology panel consensus in the context of an evolving database. Context Despite the 2010 provisional clinical opinion recommendation, there is still evidence of suboptimal hepatitis B virus (HBV) screening among patients at high risk for HBV infection or HBV reactivation after chemotherapy. This updated provisional clinical opinion introduces a risk-adaptive strategy to identify and treat patients with HBV infection to reduce their risk of HBV reactivation. Provisional Clinical Opinion Medical providers should screen by testing patients for HBV infection before starting anti-CD20 therapy or hematopoietic cell transplantation. Providers should also screen patients with risk factors for HBV infection. Screening should include both hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc), because reactivation can occur in patients who are HBsAg positive/anti-HBc positive or HBsAg negative/anti-HBc positive. Either total anti-HBc or anti-HBc immunoglobulin G (not immunoglobulin M) test should be used. Clinicians should start antiviral therapy for HBsAg-positive/anti-HBc–positive patients before or contemporaneously with cancer therapy and monitor HBsAg-negative/anti-HBc–positive patients for reactivation with HBV DNA and ALT levels, promptly starting antivirals if reactivation occurs. Clinicians can initiate antivirals for HBsAg-negative/anti-HBc–positive patients anticipating cancer therapies associated with a high risk of reactivation, or they can monitor HBV DNA and ALT levels and initiate on-demand antivirals. For patients who neither have HBV risk factors nor anticipate cancer therapy associated with a high risk of reactivation, current evidence does not support HBV screening before initiation of cancer therapy. Two panel members provided a minority viewpoint, involving a strategy of universal HBsAg and selective anti-HBc testing.

Abstract ALDH1A1 is expressed at high levels in normal HSCs and we previously reported that its function might involve metabolism of compounds termed reactive aldehydes. We also reported that loss of ALDH1A1 led to a compensatory increase in a related isoform, ALDH3A1, which also metabolizes reactive aldehydes. Double knockouts for both ALDH1A1/3A1 accumulate reactive aldehydes, which appear to impact a number of cellular processes including signal transduction and gene expression. As reactive aldehydes also cause DNA damage, we hypothesized that excess accumulation of reactive aldehydes may predispose to leukemic transformation of HSCs. In support of this, we found that ALDH1A1/3A1 double knockout HSCs readily form acute leukemia following transduction with a NUP98-HOXA10 fusion gene, which rarely causes leukemic transformation in wild type HSCs. Furthermore, in human AML, frequent absence of ALDH1A1 and the universal absence of ALDH3A1 was observed. A human AML cell line, Kasumi-1, was found to be ALDH1A1/3A1 deficient and to have high levels of intracellular reactive aldehydes. In addition, Kasumi-1 was highly sensitive to DNA damage and cell death following exposure to exogenous 4-HNE, a prototypic reactive aldehyde. In contrast, normal CD34+ HSCs were relatively resistant to 4-HNE. Based on these observations, we further hypothesized that treatment of ALDH1A1/3A1 deficient AMLs with clinically relevant compounds that further increase intracellular 4-HNE levels would selectively eliminate AML while sparing normal CD34+ HSCs. To test this, Kasumi-1 were exposed to a series of compounds including the pro-oxidant Arsenic tri-oxide (ATO), the sesquiterpene lactone parthenolide (PTL) and 4-HC, the active metabolite of cyclophosphamide (Cy) and a substrate of ALDH1A1. All increased intracellular 4-HNE levels and DNA damage. Exposure to combinations of 4-HC, ATO and PTL induced high levels of cell death in Kasumi-1. In contrast, Kasumi-1 cells engineered to express ALDH1A1 through lentiviral gene transfer and normal CD34+ HSCs were relatively resistant to several of these treatments. Primary ALDH1A1/3A1- AMLs were also relatively sensitive to treatment with these same compounds. In conclusion, ALDHs and reactive aldehydes may play important roles in HSCs and leukemia and exploitation of their biology may lead to novel therapies for AML and possibly other cancers. As an initial application of this treatment strategy, we are developing a clinical trial to treat patients with relapsed/refractory ALDH1A1/3A1 deficient AML with Cy/ATO. Disclosures: No relevant conflicts of interest to declare.

Background Globally, external HIV-related stigma is a major threat to all HIV prevention, care and treatment interventions including the recently launched Universal Test and Treat (UTT) strategy in South Africa and the 90-90-90 targets set by UNAIDS for the global response by 2020. The 90-90-90 targets are put in place to track the progression from HIV testing to durable viral load suppression among people living with HIV. The targets guide HIV programmes to achieve 90% known HIV status, to access 90% antiretroviral therapy and to suppress 90% viral loads (UNAIDS, 2017). Achievement of the 90-90-90 targets has since become a part of South Africa's National Strategic Plan for HIV, TB and STIs 2017-2022. External HIV-related stigma in this study was defined as the presence of one or more of the following attitudes and behaviours: rejection, avoidance, intolerance, stereotyping, discrimination, and physical violence towards people living or perceived as having HIV. There have not been many efforts to attenuate HIV-related stigma in South Africa, as it continues to exist. There has been a scale up of other HIV responses, such as HIV Counselling and Testing (HCT) and treatment, with the argument made that in scaling up these biomedical approaches, stigma would disappear. Furthermore, its exact magnitude, trends over the years and correlates have not been explored fully at national level, hence the present study known as Stigma Assessment Study in South Africa (SASSA). SASSA is based on the Institutional Social Construction theory framework. It explores the external HIV-related stigma magnitude and its trends between 2005 and 2012, as well as the associated factors which influence its prevalence in South Africa at a national level. The study further explores the mediating and moderating factors of external HIV-related stigma and tries to explore external HIV-related stigma by viewing individuals with HIV living in families, societies and structures, with the hope of contributing to the development of new systematic HIV-related stigma interventions in South Africa as well as, strengthening existing ones. Methodology The project used secondary data obtained from three South African national population HIV surveys which were conducted in 2005, 2008 and 2012 by a research consortium led by the Human Sciences Research Council. Sub-samples of the original surveys consisting of respondents aged 15 years and older who had responded to the stigma questions in the three surveys were extracted and included in the SASSA analysis. A nationally representative sample of a total of 16 140 individual respondents from the 2005 survey, 13 134 from the 2008 survey and 30 748 from the 2012 survey was used in the study. Two different measures of external HIV stigma are used in this analysis, one is a summary measure from the latest survey data, i.e. 2012, which was used to do a regression analysis. The summary measure was regarded as reliable to use for the regression analysis as it provides crude effect of the exposure factors on external HIV stigma. However, this summary measure was not included in the previous surveys, i.e. 2005 and 2008, and therefore could not be used for trends analysis. We therefore used 4 individual stigma items for the trends analysis as these were included in all 3 surveys. The use of 4 individual stigma items was important because when data from a variety of sources or categories have been joined together, the meaning of the data can be difficult to see. It was therefore considered ideal to assess the performance of the individual constructs on their individual contribution to the impact on HIV external stigma. Furthermore, analysis using individual constructs provided an opportunity to see specific patterns which could have remained obscure in crude analysis. The first measure of external HIV-related stigma used in the regression analysis was measured by five individual items which elicited attitudes towards people living with HIV (PLHIV). The five items were based on a 9-item scale that was originally developed and tested in a South African population, and the 9-item scale was found to be internally consistent (alpha = 0.75) and reliable (r = 0.67). The 5 items were (1) People who have AIDS are dirty; (2) People who have AIDS are cursed; (3) People who have AIDS should be ashamed; (4) People with AIDS must expect some restrictions on their freedom; (5) A person with AIDS must have done something wrong and deserves to be punished. As explained above, the specific external HIV stigma patterns second measure, which was utilized to explore stigma trends over the years 2005, 2008 and 2012, consists of four individual stigma items which elicited attitudes towards PLHIV. The four individual stigma items included: (1) If you knew that a shopkeeper or food seller had HIV, would you buy food from them? (2) Would you be willing to care for a family member with AIDS? (3) Is it a waste of money to train or give a promotion to someone with HIV/AIDS? (4) Would you want to keep the HIV positive status of a family member a secret? Findings Overall, external HIV-related stigma was found to exist among 38.3% of adult South Africans in 2012. Multiple regression analysis showed that predictors of external HIV-related stigma were race, sex, education level, self-perceived risk of HIV infection and HIV knowledge (p< 0.01). Females were less likely to report external HIV-stigma than males (AOR = 0.9, P< 0.001). Those who perceived themselves to be at high risk of HIV infection were less likely to display some stigma than those who believed they were at low risk (AOR = 0.89, p < 0.01). The study did not find any significant associations between HIV testing or awareness of HIV status, with external HIV-related stigma in this study. Looking at the individual external HIV stigma items used to measure trends, the study reveals a slight decrease in the reporting of stigma over the three time periods (2005 vs 2008 vs 2012) on responses for two of the stigma items (Q1: If you knew that a shopkeeper or food seller had HIV, would you buy food from them, and Q2: Would you be willing to care for a family member with AIDS). While an increase was observed in the reporting of stigma over the three years on responses for two of the stigma items (Q3: Is it a waste of money to train or give a promotion to someone with HIV/AIDS, and Q4: Would you want to keep the HIV positive status of a family member a secret). The structural equation modelling (SEM) showed likelihood ratio test results with a p-value greater than 0.05, a root mean square error of approximation (RMSE) of 0.008 and Tucker–Lewis index (TLI) value of 0.985. The model fit assessment results allow us to accept that an hypothesized model of the study is not far from a perfect model. The SEM results also showed a direct effect of sex on HIV knowledge statistically significant at p < 0.001, with race having an effect of 3.3% and education a direct effect of 9.5%, and both of these showed a statistically significant effect (p < 0.001) respectively. HIV knowledge showed to have a statistically significant inverse relationship on external HIV stigma of -10.4% (95% CI: -12.3-0.09) p< 0.001. Awareness of HIV status had the highest positive direct effect on external stigma of 10% (95% CI: 4.41-15.67%) p<0.001. With regard to indirect effects, sex, race, and education had minimal negative indirect effects on external stigma, which was statistically significant for all the three covariates. With the said effects of external HIV-related stigma, it was found that HIV knowledge independently mediates the relationship between Level of Education, Awareness of HIV status, Race, HIV testing history, and Sex, with External HIV-related stigma. Conclusion External HIV-related stigma still exists in South Africa despite previous success in massive ART rollout, HTC campaigns, and most recently test-and-treat programmes, which were arguably thought to have a parallel effect in the decrease of HIV related stigma. The focus on individualistic health structural approaches that do not generally have stigma-reduction as a specific aim, as discussed, is likely to undermine the successes achieved in the fight against HIV thus far. There is a need to develop innovative holistic interventions which are specifically intended for HIV stigma reduction. These should be inclusive of both social institutional elements and health structural elements to address the challenge of external HIV-related stigma.

Les résultats d’un nombre croissant d’études montrant l'effet préventif du traitement antirétroviral(TARV) sur la transmission du VIH ont jeté les bases de travaux de modélisation suggérant que ledépistage universel et répété du VIH, associé à l'initiation immédiate d’un TARV chez les personnesséropositives, pourraient infléchir l'épidémie de VIH, en particulier en Afrique sub-saharienne. On nesait pas encore si cette stratégie, qui consiste à Tester et Traiter Universellement (TTU), est réalisableau niveau populationnel, compte tenu des contraintes et du niveau requis de prise en charge du VIH quisont sans précédent.L'objectif de cette thèse était d'explorer les conditions de mise en oeuvre d’une stratégie TTU à largeéchelle. Sur la base des protocoles d'études communautaires menées en Afrique subsaharienne, nousavons caractérisé la diversité des approches TTU. Dans le cadre de l'une de ces études, l'essai ANRS12249 TasP mené dans une zone rurale d’Afrique du Sud, nous avons décrit les expériences etperceptions des travailleurs de la santé vis-à-vis de la stratégie TTU et étudié les trajectoires de soinsdes personnes vivant avec le VIH.Les résultats rapportés dans cette thèse mettent en évidence que les stratégies TTU englobent une variétéd'interventions de prise en charge du VIH, rendant complexe l'évaluation de leur impact sur l'épidémie.Les analyses des opinions des travailleurs de santé et des comportements des patients exposés à unestratégie TTU ont également permis de souligner le potentiel de la stratégie à faire évoluer les pratiquesprofessionnelles et l’accès aux soins des patients. L’ensemble de ce travail permet de mieux appréhenderles efforts nécessaires pour assurer un impact maximal d’une stratégie TTU sur la santé des populationsen Afrique subsaharienne
Increasing evidence of the preventive effect of antiretroviral treatment (ART) on HIV transmission havelaid the foundations for mathematical models to suggest that universal and repeated HIV testing,combined with immediate initiation of ART among those diagnosed HIV-positive could curtail the HIVepidemic, especially in sub-Saharan Africa. It is still unknown if this strategy, labelled as “UniversalTest and Treat” (UTT), could be workable at population level, given the unprecedented HIV servicesuptake rates that it requires.The objective of this thesis was to explore the terms of large-scale UTT implementation. Based on theprotocols of community-based trials conducted in sub-Saharan Africa, we characterized the diversity ofUTT approaches. Within the framework of one of those studies, the ANRS 12249 TasP trial, conductedin rural South Africa, we described the perceptions of health care workers regarding UTT and studiedthe care trajectories of people living with HIV from care referral to viral suppression.The findings reported in this thesis highlight that UTT strategies encompass a variety of healthinterventions, challenging the assessment of their impact on the HIV epidemic. Analyses of health careworkers opinions and patients’ behaviours when exposed to UTT underlined the potential of the strategyto change professional practices and patients’ access to care. Overall this work provides some insightson the efforts needed to allow the maximal public health impact of UTT in sub-Saharan Africa

How has government healthcare spending prepared countries for tackling the COVID-19 pandemic? Arguably, spending is the primary policy tool of governments in providing effective health. We argue that the effectiveness of spending in reducing COVID deaths is conditional on the existence of healthcare equity and lower political corruption, because the health sector is particularly susceptible to political spending. Our results, obtained using ordinary least squares (OLS) and two-stage least squares (2SLS) estimation, suggest that higher spending targeted at reducing inequitable access to health has reduced COVID deaths. Consistent with the findings of others, our results indirectly suggest that health spending is necessary, but not sufficient unless accompanied by building resilience against the spread of deadly disease. Equitable health systems ease the effects of COVID presumably because they allow states to reach and treat people. Spending aimed at increasing health system capacity by increasing access thus seems a sound strategy for fighting the spread of disease, ultimately benefiting us all.

There is a bidirectional relationship between depression and type 2 diabetes (T2D). Patients with comorbid depression and T2D are at high risk of complications and premature mortality. Conventional treatments for depression do not consistently improve diabetes outcomes, despite improving depressive symptoms. Shared mechanisms may underpin both depression and T2D, providing novel pharmacological targets to treat both conditions simultaneously. There are several candidate pathways. For inflammation and vitamin D deficiency, there is good cross-sectional evidence to support an association with depression in T2D. Prospective epidemiological studies are needed to test biological pathways as predictive biomarkers of depression and T2D. Intervention studies are needed to test the modifiability of these pathways. Repurposing of established diabetes treatments may provide a ‘multiple hit’ strategy. The identification and modification of novel biological targets has the potential to treat both depression and T2D, as well as reducing longer term morbidity and mortality.

Problems with organization, planning, strategy decisions, mental flexibility, optimizing risk/reward relationships, intiation, prioritizing, and goal setting are often called executive dysfunction. Collateral history and neuropsychological testing will help sort out the nature of the impairment but treat the patient, not the test result. Reduce barriers to optimal cognitive function: Optimize sleep; treat chronic pain; taper or stop cognitively impairing medications; stop alcohol and illicit drugs; prescribe moderate cardiovascular exercise; and refer to speech therapy and occupational therapy for executive function training. There are no specific pharmacological treatments for executive function. Consider trials of caffeine, stimulants, donepezil or rivastigmine, modafinil, or dopaminergic agents.

Problems with organization, planning, strategy decisions, mental flexibility, optimizing risk/reward relationships, prioritizing, and goal setting are often called executive dysfunction. Collateral history and neuropsychological testing will help sort out the nature of the impairment, but treat the patient, not the test results. Reduce barriers to optimal cognitive function: Optimize sleep; treat chronic pain; taper or stop cognitively impairing medications; stop alcohol and illicit drugs; prescribe moderate cardiovascular exercise; refer to speech therapy and occupational therapy for executive function training. There are no specific pharmacological treatments for executive function. Consider trials of caffeine, stimulants, donepezil or rivastigmine, modafinil, or dopaminergic agents.

This chapter explores South Korea’s responses to the Covid-19 pandemic, focusing on its innovative approach and regulatory background in implementing the so-called “test-track-treat strategy.” Years earlier, South Korea revised and introduced a regulatory framework to allow for effective responses and interventions against infectious disease outbreaks in the aftermath of its traumatic experiences with Middle East Respiratory Syndrome (MERS) in 2015. The chapter looks at how the amendments to regulations related to infectious diseases in the aftermath of the MERS outbreak have worked to South Korea’s advantage in fighting Covid-19. However, despite South Korea’s success in “flattening the curve,” its use of large-scale testing, and information and communication technology (ICT) to track patients raises controversial human rights and privacy issues. The extensive use of surveillance technologies to track and monitor individuals has the potential to infringe upon and limit fundamental human rights. The chapter then illuminates the dilemma facing South Korea between democratic governance and surveillance technology and discusses how to reconcile, through a South Korean lens, potential tensions between individual freedom and public health in a state of emergency.

In Prehistoric Times, a people fearing that they had irritated their gods would seek to make amends by sacrificing a lamb, a goat, or sometimes a young virgin. Somehow, the shedding of innocent blood effected a renewed connection between the people and their gods. A similar though seldom recognized phenomenon has occurred throughout American racial history. To settle potentially costly differences between two opposing groups of whites, a compromise is effected that depends on the involuntary sacrifice of black rights or interests. Even less recog­nized, these compromises (actually silent covenants) not only harm blacks but also disadvantage large groups of whites, including those who support the arrangements. Examples of this involuntary racial-sacrifice phenomenon abound and continue. Afew of the more important are: the slavery understandings, the Constitution, universal white male suffrage, the Dred Scott v. Sandford case, the Hayes-Tilden compromise, and the southern disenfranchisement compromise. Contemporary sacrifices of black rights and interests underlie policies on the death penalty, drug-penalty sentencing rules, and reliance on standardized test scores in college and graduate school admissions procedures. Historian Edmund Morgan explains that plantation owners in the early seventeenth century recognized that they needed a stable work force to grow and profit from tobacco. Because Native Americans woulde scape or die, and the indentures of whites came to an end, the solution, over a decade or so, was to sentence African laborers to slavery indenture for life. The landowners convinced working class whites to support African enslavement as being in their interests, eventhough these yeoman workers could never compete with wealthy land owners who could afford slaves. Slaveholders appealed to working-class whites by giving them the chance to vote and by urging them, owing to their shared whiteness, to unite against the threat of slave revolts or escapes. The strategy worked. Wealthy whites retained all their former prerogatives, but the creation of a black subclass enabled poor whites to identify with and support the policies of the upper class. With the safe economic advantage provided by their slaves, large landowners were willing to grantpoor whites a larger role in the political process. Thus, paradoxically, slavery for blacks led both to greater freedom for poor whites and aneconomic structure that would keep them poor.

Multiple Sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system. MS is typically diagnosed between the ages of 20 and 40. There is no known cause of the disease and each individual experiences varying signs and symptoms depending on the severity of their disease. The most common symptoms include tremor, debilitated gait, visual impairment, or cognitive and emotional disturbances. Current methods used to treat MS include oral medication and surgical treatment. The issues with oral medication are the unwanted side effects to otherwise healthy tissue and the lack of patient adherence. Surgical treatment can be invasive and require longer recovery times. An alternate strategy to treat MS is by increasing the knowledge base of the practitioner to potentially treat specific symptoms. Currently, physicians use observations and MRI scans of the brain and spinal cord to help diagnose and track the progression of MS. There are several studies that analyze existing assistive technology to aid in the treatment of MS tremors. Most of these studies did not involve large test groups, therefore it is difficult to prove their validity. Additionally, none of the current devices are able to track symptoms while simultaneously creating medical history records. The goal of the design is to create a new device that will obtain the frequency and amplitude of tremors, while analyzing the effects of temperature and heart rate on the intensity of the tremor. With this data, the device will advance further MS research and lead to better diagnosis and treatment.

The common approach to the modelling of spray impact is to treat the phenomenon as a simple superposition of single drop impact events [1]. The main input for such model formulation is obtained either from experimental [2,3] or theoretical [4,5,6] studies of the impact of a single drop onto a dry wall, onto a uniform, undisturbed liquid film or into a deep pool [7]. However, in [8] it was shown that this conventional approach is not universal in the description of the spray impact and that in the case of relatively dense sprays, the interaction of crowns (Fig. 1) and the oscillations of the liquid-wall film must be taken into account. For example, these interactions result in the emerging of uprising jets during spray impingement of the diesel spray (see Fig. 2). In the study of spray impact we have chosen the following strategy of the modelling: 1. Description (experimental and theoretical) of single dropimpact. Determining of the parameters influencing the splash. 2. Description of the interaction of two drops on the wall surface. 3. Determining of the parameters of the single drop impacts influencing the dynamics of the film formed on the wall. Characterization of the film: the time averaged thickness, the time averaged velocity and its fluctuations. 4. Description of the influence of the oscillating motion of the film on the outcome from a single drop impact. Single drop impact onto a wetted wall—The motion of a kinematic discontinuity in the liquid film on the wall due to the drop impact, the formation of the uprising jet at this kinematic discontinuity and its elevation are analyzed. The theory [4] for the propagation of the kinematic discontinuity is generalized for the case of arbitrary velocity vectors in the inner and outer liquid films on the wall. Next, the mass, momentum balance and Bernoulli equations at the base of the crown are considered to obtain the velocity and the thickness of the jet on the wall. An analytical solution for the crown shape is obtained in the asymptotic case of such high impact velocities that the surface tension and the viscosity effects can be neglected in comparison to inertial effects. The edge of the crown is described by the motion of a rim, formed due to the surface tension. The theoretical predictions of the height of the crown are compared with experiments. The agreement is rather good in spite of the fact that no adjustable parameters are used (see Fig. 3). Three different cases are considered: normal axisymmetric impact of a single drop, oblique impact of a single drop, and impact and interaction of two drops. Next, two new parameters of single drop impact influencing the dynamics of the film formed due to the polydisperse spray impact are identified. The first one is associated with the relative presence of the crown on the film surface and allowing one to estimate the probability of crown interactions. The second parameter is associated with the axial momentum in the plane of the wall. Time-averaged film motion—The theory of the creation of the film by spray can be subdivided into three main parts: 1. The characterization of the spray, particularly definition of the flux vectors of scalar properties (number flux vector, volume flux vector, etc.) and the momentum flux tensor. 2. Boundary conditions at the time-averaged spray/film boundary. 3. Dynamics of the film motion on the wall. The mass and momentum equations of the film are formulated accounting for the volume flux of the spray, the dynamic pressure, and the time-averaged stress vector at the film “free” surface caused by the inertia of the spray. The inertial terms of the liquid in the film contains of the inertia of the time-averaged motion and the inertia of film oscillations. These oscillations are modelled as an ensemble of the radial flows in the film associated with the single drop impacts. The probability of the crown interactions is also taken into account. Jetting at the film surface due to impingement of a dense spray—Here we consider impact of such dense sprays that the probability of single crown to propagate without interaction with another crown is very small. The non-uniformities in the dynamic pressure in such sprays yields the significant fluctuations in the film velocity leading to the shocks and jetting (as in the case of the diesel spray impact shown in Fig. 2). We describe the statistically averaged distribution of drop impacts around a given drop assuming that all the impacting drops are distributed randomly in space and in time. The statistically averaged dynamic pressure around given drop is not uniform either in the time or in the radial direction. The self-similar solution for the statistically averaged radial velocity in the film and its thickness (Fig. 4) is obtained. The characteristic time of the instant of shock is estimated. The theoretical predictions of the jets diameter agree with the experimental data in the order of the magnitude.

The current investigation was done to assess the autarchical and antimicrobes action of Germane sylvestre against ten microbial strains causing oral contaminations. The subjective autarchical examinations were completed after the Ukn pharmacopeia and the techniques. The MIC estimations of the plant extricates were resolved against the chose test life forms utilizing the techniques as depicted by National Committee for Chemical Laboratory Standard and the in vitro antimicrobes movement was controlled by utilizing the agar plate dissemination strategy. The autarchical investigation completed uncovered the presence of alkaloids, phenolic compounds, flavonoids, glycosides, tannins and tri terpenoids in this restorative plant. The antimicrobes movement of five distinct concentrates of therapeutic plants were assessed utilizing admirably dissemination technique against Staphylococcus aureus, Streptococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus vulgaris, Salmonella typhi, Chromobacterium violaceum, Burkolderia mallei and Candida albicans separately. The chloroform concentrates of this plant shown best antimicrobes movement against chose organisms. The outcomes give defense to the utilization of the restorative plants to treat different oral contaminations.

Surface Piercing Propeller (SPP) can achieve high propulsive efficiency on high-speed vessels planing to reduce the frictional resistance of hull. It has the characteristic blade section and works partially submerged condition. The blades repeat entry to and exit from the water free surface and the suction sides and trailing edge of blades are exposed to ventilated cavitation while they are under the water. And interface near SPP is severely deformed by the high rotating blades. This working condition of SPP, therefore, makes it hard that propeller open characteristics are estimated with high reliability. Because SPP is unusual propeller having above difficulty of the performance estimation, the studies for SPP are few compared with large sized propellers for merchant ships. Although the various model tests had been carried out to understand the physical phenomena around various SPPs and their effects on propeller performances, they were not universal approach with standardized test conditions and propeller shape, as mentioned in 23th ITTC report and recommendation (2002). In applying the conventional calculation based on potential theory to SPP, there are many difficulties to model the physical phenomena theoretically. In calculations by Furuya (1984, 1985), thickness of blade and ventilated cavitation were non-consideration, and it was assumed that the suction side of the blade was fully ventilated in the water. In calculations by Young and Kinnas (2001), the interface deformation near SPP was not modeled theoretically. Therefore, they attributed the difference from experimental results to the effect of incompleteness of numerical modeling. On the other hand, CFD analysis can treat the effects of physical phenomena including thick ventilated cavitation and the sharp deformation of interface around SPP. In addition, the characteristic blade shape is modeled accurately without the geometric limitation in CFD. In this paper, typical SPP with experimental results open to the public is analyzed by CFD-RANS approach using Volume of Fluid (VOF) method based on interface-capturing algorithm at wide range of propeller advance coefficient J. Regarding propeller open characteristics, the 6-component force/moment fluctuations by blade rotations, and ventilation patterns, analyses results are compared with measured values. Moreover, the results of simulations in various Froude numbers and Weber numbers are evaluated whether their effects were negligible when they are sufficiently high, in the same manner as the results found by the other’s experimental studies (Shiba, 1953; Brandt, 1973).

Fault monitoring of the upstream universal exhaust gas oxygen (UEGO) sensor, as mandated by the California air resources board (CARB), is a necessary action to maintain the performance of the operation of the air-fuel ratio (AFR) control system and indicate the need for maintenance when a fault is present which could potentially lead to exceeding the emissions limits. When the UEGO sensor fault is accurately diagnosed, i.e. fault is detected, direction is identified and magnitude is estimated, tuning of the controller gains can be performed accurately with minimal calibration efforts. Presented in this paper is a control strategy that utilizes the type, direction and magnitude of fault detected to adapt the gains of the controller and update the parameters of the Smith predictor (SP) in order to maintain the stability of AFR control loop. The proposed approach has been validated on a vehicle (Mustang V6 3.7L) equipped with ATI No-Hooks rapid prototyping system. Different fault types and magnitudes were tested and the tailpipe emissions were assessed on federal test procedure (FTP) cycles.

On-Board Diagnostics (OBD) regulations impose missing combustions detection within a wide portion of the engine operating range. Missing combustions can be caused either by ignition (misfire) or injection (misfuel) system failures. Missing combustions can damage the catalyst and cause abrupt pollutants increases (especially HC), but misfuels are not as detrimental as misfires, both from the emissions and the after treatment system life point of view. It would be important for the Electronic Control Unit (ECU) to be informed not only about the fault event, but also about its type, for the purpose of setting the right recovery strategy. The aim of this paper is to analyze missing combustion phenomena, in order to find out if a fault recognition strategy able to distinguish between misfire and misfuel can be setup. Different approaches can be found in the literature to diagnose missing combustions: many of them are based on the speed signal analysis, both in time and frequency domains, others use the knock accelerometer signal, or the exhaust manifold pressure information. A Universal Exhaust Gas Oxygen (UEGO) sensor can also be used. Usually diagnosis methodologies consist in observing signals perturbations subsequent to the malfunction event. Observable consequences of missing combustions are, for example, a sudden lack of indicated torque, causing vibrations and speed fluctuations, an increasing in exhaust gases Oxygen content, anomalous exhaust pressure ripples, etc. Many phenomena interact influencing in different ways the engine behavior, during and after the fault event: their effect can depend on the fault cause, thus helping the recognition. The first combustion taking place in the faulty cylinder after a misfire (post-misfiring cycle) usually leads to higher indicated pressure and torque levels if compared to standard values for the same operating conditions, while the same cannot be said for the post-misfueling combustion. On the other side, Air-Fuel Ratio (AFR) assumes different trends during the misfiring and post-misfiring cycles, with respect to misfueling and post-misfueling cycles. A 4 cylinders 1.2 liters spark ignition port injected engine, equipped with a programmable Electronic Control Unit (ECU) has been tested on the test bench, inducing both misfires and misfuels, over a wide engine operating range, while monitoring the engine faulty behavior. Misfire and misfuel-related phenomena have been analyzed showing their “signature” on indicated pressure and torque, engine speed and Air-Fuel Ratio measured signals, in order to define the most reliable recognition strategy.