Riviste scientifiche

AI construction worker plans the fastest way to put up buildings

New Scientist - Me, 06/06/2018 - 13:22
By considering hundreds of millions of potential schedules, an AI construction manager works out the best and fastest way for builders to put up a new building

4-year-olds care more about plants and animals than sick people

New Scientist - Me, 06/06/2018 - 13:16
When we’re young, we care less about people – so much so that 4-year-olds care less about teachers and police than they do about dogs, monkeys and rosebushes

Europeans now burn more palm oil in their cars than they eat

New Scientist - Me, 06/06/2018 - 12:42
Palm oil consumption in the EU jumped by 7 per cent in 2017 because it is increasingly used as a biofuel – driving the destruction of orangutans’ habitat

Estimating the real-world effects of expanding antiretroviral treatment eligibility: Evidence from a regression discontinuity analysis in Zambia

PLoS Medicine - Ma, 05/06/2018 - 23:00

by Aaloke Mody, Izukanji Sikazwe, Nancy L. Czaicki, Mwanza Wa Mwanza, Theodora Savory, Kombatende Sikombe, Laura K. Beres, Paul Somwe, Monika Roy, Jake M. Pry, Nancy Padian, Carolyn Bolton-Moore, Charles B. Holmes, Elvin H. Geng

Background

Although randomized trials have established the clinical efficacy of treating all persons living with HIV (PLWHs), expanding treatment eligibility in the real world may have additional behavioral effects (e.g., changes in retention) or lead to unintended consequences (e.g., crowding out sicker patients owing to increased patient volume). Using a regression discontinuity design, we sought to assess the effects of a previous change to Zambia’s HIV treatment guidelines increasing the threshold for treatment eligibility from 350 to 500 cells/μL to anticipate effects of current global efforts to treat all PLWHs.

Methods and findings

We analyzed antiretroviral therapy (ART)-naïve adults who newly enrolled in HIV care in a network of 64 clinics operated by the Zambian Ministry of Health and supported by the Centre for Infectious Disease Research in Zambia (CIDRZ). Patients were restricted to those enrolling in a narrow window around the April 1, 2014 change to Zambian HIV treatment guidelines that raised the CD4 threshold for treatment from 350 to 500 cells/μL (i.e., August 1, 2013, to November 1, 2014). Clinical and sociodemographic data were obtained from an electronic medical record system used in routine care. We used a regression discontinuity design to estimate the effects of this change in treatment eligibility on ART initiation within 3 months of enrollment, retention in care at 6 months (defined as clinic attendance between 3 and 9 months after enrollment), and a composite of both ART initiation by 3 months and retention in care at 6 months in all new enrollees. We also performed an instrumental variable (IV) analysis to quantify the effect of actually initiating ART because of this guideline change on retention. Overall, 34,857 ART-naïve patients (39.1% male, median age 34 years [IQR 28–41], median CD4 268 cells/μL [IQR 134–430]) newly enrolled in HIV care during this period; 23,036 were analyzed after excluding patients around the threshold to allow for clinic-to-clinic variations in actual guideline uptake. In all newly enrolling patients, expanding the CD4 threshold for treatment from 350 to 500 cells/μL was associated with a 13.6% absolute increase in ART initiation within 3 months of enrollment (95% CI, 11.1%–16.2%), a 4.1% absolute increase in retention at 6 months (95% CI, 1.6%–6.7%), and a 10.8% absolute increase in the percentage of patients who initiated ART by 3 months and were retained at six months (95% CI, 8.1%–13.5%). These effects were greatest in patients who would have become newly eligible for ART with the change in guidelines: a 43.7% increase in ART initiation by 3 months (95% CI, 37.5%–49.9%), 13.6% increase in retention at six months (95% CI, 7.3%–20.0%), and a 35.5% increase in the percentage of patients on ART at 3 months and still in care at 6 months [95% CI, 29.2%–41.9%). We did not observe decreases in ART initiation or retention in patients not directly targeted by the guideline change. An IV analysis found that initiating ART in response to the guideline change led to a 37.9% (95% CI, 28.8%–46.9%) absolute increase in retention in care. Limitations of this study include uncertain generalizability under newer models of care, lack of laboratory data (e.g., viral load), inability to account for earlier stages in the HIV care cascade (e.g., HIV testing and linkage), and potential for misclassification of eligibility status or outcome.

Conclusions

In this study, guidelines raising the CD4 threshold for treatment from 350 to 500 cells/μL were associated with a rapid rise in ART initiation as well as enhanced retention among newly treatment-eligible patients, without negatively impacting patients with lower CD4 levels. These data suggest that health systems in Zambia and other high-prevalence settings could substantially enhance engagement even among those with high CD4 levels (i.e., above 500 cells/μL) by expanding treatment without undermining existing care standards.

The New Horizons probe is awake and ready for its next flyby

New Scientist - Ma, 05/06/2018 - 17:07
For the last 6 months, the New Horizons spacecraft that flew past Pluto in 2015 has been in hibernation, hurtling towards a distant rock – it has just woken up

Bizarre state of matter to treat wounds instead of antibiotics

New Scientist - Ma, 05/06/2018 - 14:29
Plasma is a state of matter, like liquid or gas, that is fatal to bacteria, so a new wearable plasma patch is being tested to dress wounds

The most elusive whales reveal their secrets in their wakes

New Scientist - Ma, 05/06/2018 - 14:20
We know almost nothing about the enormous beaked whales because they spend so much time deep underwater, but a new DNA technique could unmask them

What can game theory tell us about Trump’s threats of trade war?

New Scientist - Ma, 05/06/2018 - 12:24
Theories of conflict and cooperation say the US risks self-harm if it sparks a big trade war. So what is Trump's real aim, wonders Petros Sekeris

Quantum computers are weirder and more powerful than we thought

New Scientist - Ma, 05/06/2018 - 12:23
A theoretical breakthrough has shown that quantum computers are not just faster versions of ordinary computers, but something much stranger

Cosmic cooperation is just what space exploration needs

New Scientist - Ma, 05/06/2018 - 11:00
Questions such as whether Mars ever hosted life are too big to be left to any one nation – efforts to join forces on space missions are the future

Two meteors in two days lit up the sky in China and Botswana

New Scientist - Ma, 05/06/2018 - 00:02
On 1 and 2 June, two meteors streaked across the sky, one in China and one in southern Africa. One of them was the third we’ve ever detected before it hit Earth

A day used to be less than 19 hours long 1.4 billion years ago

New Scientist - Lu, 04/06/2018 - 22:00
The moon is making days on Earth last longer and longer, and we can track the changes through climate effects seen in the geological record

Mystery of why Stone Age villagers spent so much time underwater

New Scientist - Lu, 04/06/2018 - 19:30
Half of the adults at a Stone Age village in Turkey had a strange ear condition most common today in keen surfers – but why did they spend so much time in water?

Woman survives metastatic breast cancer thanks to new treatment

New Scientist - Lu, 04/06/2018 - 18:00
A therapy that targets the immune system has had dramatic results in people with four types of cancer in advanced stages that were previously untreatable

Zambia to kill 2000 hippos because they might spread anthrax

New Scientist - Lu, 04/06/2018 - 17:50
Over the next five years 2000 hippos are to be culled in Zambia, supposedly to stop them giving people anthrax, but the cull may inadvertently fuel the trade in hippo ivory

Guatemala volcano kills 75 as ash buries entire villages

New Scientist - Lu, 04/06/2018 - 13:17
The Fuego volcano in Guatemala has exploded and spewed out molten rock and ash, killing at least 75 people in the country's most violent eruption for over a century

A whole new type of cancer therapy helps treat liver cancer

New Scientist - Lu, 04/06/2018 - 13:09
By making a gene in the liver work harder, a completely new type of drug has shown promise for treating cases of advanced liver cancer in a small trial

Anti-swearing AI takes the edge off abuse on Reddit and Twitter

New Scientist - Lu, 04/06/2018 - 12:33
Artificial intelligence created by IBM converts offensive abuse on sites like Reddit and Twitter into more polite patter

It’s time we stopped dismissing women’s health problems

New Scientist - Lu, 04/06/2018 - 12:00
Controversy about cervical smear tests is just the latest in a series concerning women’s health. It’s time to talk about inequality in the doctor’s surgery
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