Quality and hydrochemical assessment of groundwater in geological transition zones: a case study from N.E. Nigeria.

Sustainable management of groundwater resources in geological transition zones (GTZ) is essential due to their complex geology, increasing population, industrialization, and climate change. Groundwater quality monitoring and assessment represent a viable panacea to this problem. Therefore, there is a great need to investigate groundwater resources in terms of their chemistry and pollution to ascertain their quality and implement robust pollution abatement strategies. This study focused on the characterization of groundwater in a typical geological transition zone in northeastern Nigeria. Eighty-seven (87) groundwater samples were collected from dug wells and boreholes during the 2017 dry season. pH, conductivity, and total dissolved solids (TDS) were measured in situ using a multiparameter probe, while major cations and anions were measured using atomic absorption spectrometry and ion chromatography, respectively. Data were analyzed using descriptive statistics, principal component analysis (PCA), water quality index, and standard hydrochemical plots. TDS ranged between 95 and 1154 mg L-1 in basement terrains and between 49 and 1105 in sedimentary areas. pH ranged between 6.8 and 7.7 mg L-1 in basement terrains and between 5.0 and 6.5 in sedimentary areas, suggesting a moderately acidic to alkaline low mineralized groundwater. Calcium (2.6-128.0 mg L-1) was the dominant cation in the basement areas, suggesting silicate weathering/dissolution, while sodium (1.9-106.0 mg L-1) dominated the sedimentary zones due to base exchange reactions. The PCA analysis suggests that mineral dissolution (mostly silicate weathering) controls the hydrochemistry of the basement aquifers, while ion exchange and albite weathering, with some influence of anthropogenic factor, control the sedimentary aquifers. The water quality index revealed that the basement setting was predominated by poor to unsuitable groundwater, while the sedimentary terrain was characterized by potable groundwater. The dominant hydrochemical facie in the basement areas was Ca2+-(Mg2+)-HCO3- characteristic of recharge meteoric water. The Na+- (K+)-HCO3- facie characterized the sedimentary zones, indicative of cation exchange reactions, while the mixed water facie typifies the geological contact zones. The shallow nature of the basement groundwaters makes them more susceptible to geogenic and anthropogenic pollution compared to the sandstone aquifers. However, the basement aquifers have better irrigation indices (Kelly ratio and soluble sodium percent) as compared to the sandstone aquifers, which exhibit poor Kelly ratios (< 1) and soluble sodium percent (> 50) ratings. Results from the study clearly highlight the poor-unsuitable groundwater quality in parts of the studied GTZ and can be very instrumental to the policymakers in implementing sustainable water treatment strategies and cleaner production technologies in GTZ to forestall the incidence of water-related diseases.

Agent-based model projections for reducing HIV infection among MSM: Prevention and care pathways to end the HIV epidemic in Chicago, Illinois.

Our objective is to improve local decision-making for strategies to end the HIV epidemic using the newly developed Levers of HIV agent-based model (ABM). Agent-based models use computer simulations that incorporate heterogeneity in individual behaviors and interactions, allow emergence of systemic behaviors, and extrapolate into the future. The Levers of HIV model (LHM) uses Chicago neighborhood demographics, data on sex-risk behaviors and sexual networks, and data on the prevention and care cascades, to model local dynamics. It models the impact of changes in local preexposure prophylaxis (PrEP) and antiretroviral treatment (ART) (ie, levers) for meeting Illinois' goal of "Getting to Zero" (GTZ) -reducing by 90% new HIV infections among men who have sex with men (MSM) by 2030. We simulate a 15-year period (2016-2030) for 2304 distinct scenarios based on 6 levers related to HIV treatment and prevention: (1) linkage to PrEP for those testing negative, (2) linkage to ART for those living with HIV, (3) adherence to PrEP, (4) viral suppression by means of ART, (5) PrEP retention, and (6) ART retention. Using tree-based methods, we identify the best scenarios at achieving a 90% HIV infection reduction by 2030. The optimal scenario consisted of the highest levels of ART retention and PrEP adherence, next to highest levels of PrEP retention, and moderate levels of PrEP linkage, achieved 90% reduction by 2030 in 58% of simulations. We used Bayesian posterior predictive distributions based on our simulated results to determine the likelihood of attaining 90% HIV infection reduction using the most recent Chicago Department of Public Health surveillance data and found that projections of the current rate of decline (2016-2019) would not achieve the 90% (p = 0.0006) reduction target for 2030. Our results suggest that increases are needed at all steps of the PrEP cascade, combined with increases in retention in HIV care, to approach 90% reduction in new HIV diagnoses by 2030. These findings show how simulation modeling with local data can guide policy makers to identify and invest in efficient care models to achieve long-term local goals of ending the HIV epidemic.

Stimulant use interventions may strengthen 'Getting to Zero' HIV elimination initiatives in Illinois: Insights from a modeling study.

OBJECTIVE(S): Getting to Zero (GTZ) is an Illinois-based HIV elimination initiative. GTZ identifies younger Black men who have sex with men (YBMSM) as a population who have experienced disproportionate HIV incidence. Rising stimulant use among YBMSM has been determined to impede engagement in the HIV prevention and treatment continua for reducing onward HIV transmission. Given the limited development of dedicated or culturally appropriate interventions for this population, this modeling study explores the impact of stimulant use on HIV incidence among YBMSM and assesses the impact of interventions to treat stimulant use on downstream HIV transmission to achieve GTZ goals. METHODS: A previously developed agent-based network model (ABNM), calibrated using data for YBMSM in Illinois, was extended to incorporate the impact of stimulant use (methamphetamines, crack/cocaine, and ecstasy) on sexual networks and engagement in HIV treatment and prevention continua. The model simulated the impact of a residential behavioral intervention (BI) for reducing stimulant use and an outpatient biomedical intervention (mirtazapine) for treating methamphetamine use. The downstream impact of these interventions on population-level HIV incidence was the primary intervention outcome. RESULTS: Baseline simulated annual HIV incidence in the ABNM was 6.93 [95% Uncertainty Interval (UI): 6.83,7.04] per 100 person years (py) and 453 [95% UI: 445.9,461.2] new infections annually. A residential rehabilitation intervention targeted to 25% of stimulant using persons yielded a 27.1% reduction in the annual number of new infections. Initiating about 50% of methamphetamine using persons on mirtazapine reduced the overall HIV incidence among YBMSM by about 11.2%. A 30% increase in antiretroviral treatment (ART) and preexposure prophylaxis (PrEP) uptake in the non-stimulant using YBMSM population combined with a 25% uptake of BI for stimulant using persons produces an HIV incidence consistent with HIV elimination targets (about 200 infections/year) identified in the GTZ initiative. CONCLUSIONS: Behavioral and biomedical interventions to treat stimulant use, in addition to expanding overall ART and PrEP uptake, are likely to enhance progress towards achieving GTZ goals.

Getting to zero HIV/AIDS in sub-Saharan Africa: Understanding perceptions of locals using the social determinants of health framework.

This study explored a community perception of the facilitators and inhibitors of Getting to Zero (GTZ) in rural Zambia, sub-Saharan Africa. Data were collected in 2017. We use the Social Determinants of Health framework to guide organisation of key themes emerging from semistructured, focus group interviews with community members (N = 52). Data were analysed through an iterative descriptive/thematic approach which allowed for the highlighting of key themes. Emerging themes point to the significance of (a) individual, (b) sociocultural, (c) environmental and (d) economic factors, for example, treatment adherence, gender norms, food security and access to health care as important in GTZ. Implications for policy, practise and scholarship are suggested.

Rational design of non-toxic GOx-based biocatalytic nanoreactor for multimodal synergistic therapy and tumor metastasis suppression.

Rationale: Glucose oxidase (GOx)-based biocatalytic nanoreactors can cut off the energy supply of tumors for starvation therapy and deoxygenation-activated chemotherapy. However, these nanoreactors, including mesoporous silica, calcium phosphate, metal-organic framework, or polymer nanocarriers, cannot completely block the reaction of GOx with glucose in the blood, inducing systemic toxicity from hydrogen peroxide (H2O2) and anoxia. The low enzyme loading capacity can reduce systemic toxicity but limits its therapeutic effect. Here, we describe a real 'ON/OFF' intelligent nanoreactor with a core-shell structure (GOx + tirazapamine (TPZ))/ZIF-8@ZIF-8 modified with the red cell membrane (GTZ@Z-RBM) for cargo delivery. Methods: GTZ@Z-RBM nanoparticles (NPs) were prepared by the co-precipitation and epitaxial growth process under mild conditions. The core-shell structure loaded with GOx and TPZ was characterized for hydrate particle size and surface charge. The GTZ@Z-RBM NPs morphology, drug, and GOx loading/releasing abilities, system toxicity, multimodal synergistic therapy, and tumor metastasis suppression were investigated. The in vitro and in vivo outcomes of GTZ@Z-RBM NPs were assessed in 4T1 breast cancer cells. Results: GTZ@Z-RBM NPs could spatially isolate the enzyme from glucose in a physiological environment, reducing systemic toxicity. The fabricated nanoreactor with high enzyme loading capacity and good biocompatibility could deliver GOx and TPZ to the tumors, thereby exhausting glucose, generating H2O2, and aggravating hypoxic microenvironment for starvation therapy, DNA damage, and deoxygenation-activated chemotherapy. Significantly, the synergistic therapy effectively suppressed the breast cancer metastasis in mice and prolonged life without systemic toxicity. The in vitro and in vivo results provided evidence that our biomimetic nanoreactor had a powerful synergistic cascade effect in treating breast cancer. Conclusion: GTZ@Z-RBM NPs can be used as an 'ON/OFF' intelligent nanoreactor to deliver GOx and TPZ for multimodal synergistic therapy and tumor metastasis suppression.

Association Between Diabetes Medications and the Risk of Parkinson's Disease: A Systematic Review and Meta-Analysis.

Background: Diabetes mellitus (DM) increases the risk of Parkinson's disease (PD). However, whether DM medications play a part on that increased PD risk is unclear. We designed this meta-analysis to assess the influence of different oral DM medications on the PD risk in patients with DM. Methods: We searched PubMed, Embase, and CENTRAL databases for relevant studies up until January 2021. We pooled adjusted outcomes to assess the PD risk in patients using different DM medications including sulfonylurea, metformin, glitazones (GTZ), dipeptidyl peptidase-4 inhibitors (DPP4i), and glucagon-like peptide-1 agonists (GLP1a). Results: We included 10 studies in our analysis. Our results indicate a lack of significant association between the PD risk and the use of sulfonylureas (three studies; HR, 1.26; 95% CI, 0.95 to 1.66; I 2, 70%; p = 0.11), DPP4i (three studies; HR, 0.69; 95% CI, 0.35 to 1.38; I 2, 88%; p = 0.30), metformin (five studies; HR, 1.23; 95% CI, 0.98 to 1.78; I 2, 84%; p = 0.13), and GTZ (six studies; HR, 0.88; 95% CI, 0.66 to 1.16; I 2, 92%; p = 0.35). After exclusion of a single study in the GTZ analysis, our results indicate a significantly reduced PD risk with GTZ use (HR, 0.78; 95% CI, 0.65 to 0.93; I 2, 59%; p = 0.06). Similarly, after the exclusion of a single study, our results indicate a significantly increased PD risk with the use of metformin (HR, 1.50; 95% CI, 1.11 to 2.02; I 2, 80%; p = 0.008). We also found a significantly reduced PD risk with the use of GLP1a (two studies; HR, 0.41; 95% CI, 0.19 to 0.87; I 2, 0%; p = 0.02). Conclusion: The role of different DM medications on the PD risk remains unclear, and the quality of studies is low. While our analysis suggests a lack of association between the use of metformin, GTZ, DPP4i, and sulfonylureas and the PD risk, metformin (to a higher degree) and GTZ may still increase the risk. Limited data suggest a protective effect of GLP1a on the PD risk.

Projecting the number of new HIV infections to formulate the "Getting to Zero" strategy in Illinois, USA.

OBJECTIVES: Getting to Zero (GTZ) initiatives focus on expanding use of antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) to eliminate new HIV infections. Computational models help inform policies for implementation of ART and PrEP continuums. Such models, however, vary in their design, and may yield inconsistent predictions. Using multiple approaches can help assess the consistency in results obtained from varied modeling frameworks, and can inform optimal implementation strategies. METHODS: A study using three different modeling approaches is conducted. Two approaches use statistical time series analysis techniques that incorporate temporal HIV incidence data. A third approach uses stochastic stimulation, conducted using an agent-based network model (ABNM). All three approaches are used to project HIV incidence among a key population, young Black MSM (YBMSM), over the course of the GTZ implementation period (2016-2030). RESULTS: All three approaches suggest that simultaneously increasing PrEP and ART uptake is likely to be more effective than increasing only one, but increasing ART and PrEP by 20% points may not eliminate new HIV infections among YBMSM. The results further suggest that a 20% increase in ART is likely to be more effective than a 20% increase in PrEP. All three methods consistently project that increasing ART and PrEP by 30% simultaneously can help reach GTZ goals. CONCLUSIONS: Increasing PrEP and ART uptake by about 30% might be necessary to accomplish GTZ goals. Such scale-up may require addressing psychosocial and structural barriers to engagement in HIV and PrEP care continuums. ABNMs and other flexible modeling approaches can be extended to examine specific interventions that address these barriers and may provide important data to guide the successful intervention implementation.

Evidence Regarding Rapid Initiation of Antiretroviral Therapy in Patients Living with HIV.

PURPOSE OF REVIEW: Rapid initiation of antiretroviral therapy (ART) is increasingly more common among clinics serving people living with human immunodeficiency virus (PLWH). It is recommended by major guidelines and is especially important in achieving the Getting to Zero (GTZ) goals by 2030. Patients should be offered the option to initiate ART as soon as possible, preferably at time of HIV diagnosis, with the goal of reducing transmission, morbidity, and mortality. RECENT FINDINGS: Three published randomized controlled trials, and several other observational, prospective, and retrospective studies, demonstrated superior rates of viral suppression (VS) with initiation of rapid ART compared to standard of care. Improved time to VS and retention in care were also observed. Based on the regimens studied, a tenofovir backbone combined with an integrase strand transfer inhibitor or protease inhibitor is recommended for rapid start initiation. Since ART is started earlier compared with standard of care, there is opportunity to achieve VS at a much faster rate, especially in the setting of starting on the day of diagnosis. What requires further evaluation is whether or not VS is sustained over time with quicker linkage and initiation of HIV care. SUMMARY: Initiating rapid ART in newly diagnosed PLWH provides a promising approach to achieving GTZ. When offered rapid ART, virologic suppression is improved compared to standard of care, which may reduce transmission and, ultimately, new HIV infections.

Diabetes medications and risk of Parkinson's disease: a cohort study of patients with diabetes.

The elevated risk of Parkinson's disease in patients with diabetes might be mitigated depending on the type of drugs prescribed to treat diabetes. Population data for risk of Parkinson's disease in users of the newer types of drugs used in diabetes are scarce. We compared the risk of Parkinson's disease in patients with diabetes exposed to thiazolidinediones (glitazones), glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase 4 (DPP4) inhibitors, with the risk of Parkinson's disease of users of any other oral glucose lowering drugs. A population-based, longitudinal, cohort study was conducted using historic primary care data from The Health Improvement Network. Patients with a diagnosis of diabetes and a minimum of two prescriptions for diabetes medications between January 2006 and January 2019 were included in our study. The primary outcome was the first recording of a diagnosis of Parkinson's disease after the index date, identified from clinical records. We compared the risk of Parkinson's disease in individuals treated with glitazones or DPP4 inhibitors and/or GLP-1 receptor agonists to individuals treated with other antidiabetic agents using a Cox regression with inverse probability of treatment weighting based on propensity scores. Results were analysed separately for insulin users. Among 100 288 patients [mean age 62.8 years (standard deviation 12.6)], 329 (0.3%) were diagnosed with Parkinson's disease during the median follow-up of 3.33 years. The incidence of Parkinson's disease was 8 per 10 000 person-years in 21 175 patients using glitazones, 5 per 10 000 person-years in 36 897 patients using DPP4 inhibitors and 4 per 10 000 person-years in 10 684 using GLP-1 mimetics, 6861 of whom were prescribed GTZ and/or DPP4 inhibitors prior to using GLP-1 mimetics. Compared with the incidence of Parkinson's disease in the comparison group (10 per 10 000 person-years), adjusted results showed no evidence of any association between the use of glitazones and Parkinson's disease [incidence rate ratio (IRR) 1.17; 95% confidence interval (CI) 0.76-1.63; P = 0.467], but there was strong evidence of an inverse association between use of DPP4 inhibitors and GLP-1 mimetics and the onset of Parkinson's disease (IRR 0.64; 95% CI 0.43-0.88; P < 0.01 and IRR 0.38; 95% CI 0.17-0.60; P < 0.01, respectively). Results for insulin users were in the same direction, but the overall size of this group was small. The incidence of Parkinson's disease in patients diagnosed with diabetes varies substantially depending on the treatment for diabetes received. The use of DPP4 inhibitors and/or GLP-1 mimetics is associated with a lower rate of Parkinson's disease compared to the use of other oral antidiabetic drugs.

A modeling framework to inform preexposure prophylaxis initiation and retention scale-up in the context of 'Getting to Zero' initiatives.

OBJECTIVE(S): 'Getting to Zero' (GTZ) initiatives aim to eliminate new HIV infections over a projected time frame. Increased preexposure prophylaxis (PrEP) uptake among populations with the highest HIV incidence, such as young Black MSM, is necessary to accomplish this aim. Agent-based network models (ABNMs) can help guide policymakers on strategies to increase PrEP uptake. DESIGN: Effective PrEP implementation requires a model that incorporates the dynamics of interventions and dynamic feedbacks across multiple levels including virus, host, behavior, networks, and population. ABNMs are a powerful tool to incorporate these processes. METHODS: An ABNM, designed for and parameterized using data for young Black MSM in Illinois, was used to compare the impact of PrEP initiation and retention interventions on HIV incidence after 10 years, consistent with GTZ timelines. Initiation interventions selected individuals in serodiscordant partnerships, or in critical sexual network positions, and compared with a controlled setting where PrEP initiators were randomly selected. Retention interventions increased the mean duration of PrEP use. A combination intervention modeled concurrent increases in PrEP initiation and retention. RESULTS: Selecting HIV-negative individuals for PrEP initiation in serodiscordant partnerships resulted in the largest HIV incidence declines, relative to other interventions. For a given PrEP uptake level, distributing effort between increasing PrEP initiation and retention in combination was approximately as effective as increasing only one exclusively. CONCLUSION: Simulation results indicate that expanded PrEP interventions alone may not accomplish GTZ goals within a decade, and integrated scale-up of PrEP, antiretroviral therapy, and other interventions might be necessary.

Diagnóstico de áreas contaminadas pela disposição final de resíduos sólidos no município de Paço do Lumiar (MA) / Diagnosis of contaminated areas by final disposal of solid waste in the municipality of Paço do Lumiar (MA), Brazil

RESUMO A disposição final de resíduos sólidos é considerada uma fonte potencial de contaminação e tem merecido destaque em função dos problemas ambientais e socioeconômicos que pode gerar. O município de Paço do Lumiar, no Maranhão, utiliza um lixão como forma de disposição de resíduos sólidos urbanos mesmo após ter cessado o prazo para o fim dos lixões no Brasil conforme a Política Nacional de Resíduos Sólidos, Lei Federal nº 12.305, de 2 de agosto de 2010. Em virtude disso, este estudo teve como objetivo detectar áreas contaminadas pela disposição de resíduos sólidos em Paço do Lumiar com base na metodologia do Manual de Gerenciamento de Áreas Contaminadas do projeto CETESB/GTZ (1999), utilizando os compartimentos ambientais solo e água superficial como objetos de análise. Assim, verificou-se que o lixão tem contribuído para a contaminação do solo com metais pesados no local de disposição e a 200 m a sua jusante, o que pode significar contaminação potencial da água subterrânea em virtude de a geologia local e o solo arenoso serem facilitadores no processo de transporte de contaminantes. Já a análise da água superficial revelou que a disposição de resíduos sólidos pode estar contribuindo menos que outras fontes de contaminação, destacando-se, nesse contexto, os efluentes gerados pelas comunidades que ocupam a bacia. Portanto, como a contaminação verificada compromete alguns usos da terra (residencial e agrícola), estudos posteriores poderão contemplar o processo de remediação de áreas contaminadas conforme material da CETESB/GTZ (1999) para que medidas corretivas minimizem os impactos ambientais na região.

ABSTRACT The final disposal of solid waste is considered a potential source of contamination and has been highlighted due to the environmental problems and socioeconomic factors that it can generate. The municipality of Paço do Lumiar, Maranhão, uses a garbage dump as a way of disposing urban solid waste, even after the deadline for the end of dumps in Brazil, as established by the National Solid Waste Policy, Federal Law No. 12,305, dated August 2, 2010. As a result, the objective of this study was to detect areas contaminated by disposal of solid waste in Paço do Lumiar, based on the Workshop Management of Contaminated Areas' methodology, a part of the project CETESB/GTZ (1999), using the environmental compartments soil and surface water as objects of analysis. Thus, it was found that the garbage dump has contributed to the contamination of soil with heavy metals in the place of provision and 200m to its downstream, which can mean potential contamination of ground water due to the local geology and the fact that sandy soil facilitates the process of transporting contaminants. The analysis of the surface water revealed that the disposal of solid waste can contribute less than other sources of contamination, highlighting in this context those generated by the communities that occupy the basin. Therefore, as the verified contamination compromises some land uses (residential and agricultural), further studies may contemplate the remediation process of these contaminated areas according to the CTESB/GTZ (1999) material for stablishing measures to minimize this region's environmental impacts.

Sequestration of Aluminium(III) by different natural and synthetic organic and inorganic ligands in aqueous solution.

The speciation of Al3+ in aqueous solutions containing organic and inorganic ligands important from a biological (citrate (Cit3-), gluconate (Gluc-), lactate (Lac-), silicate (H2SiO42-), carbonate (CO32-), fluoride (F-)) and industrial (Gantrez®; polymethyl-vinyl-ether-co-maleic acids; GTZ S95 and GTZ AN169) point of view is reported. The stability constants of Al3+/Lz- complexes (Lz- = ligand with z- charge) were determined by potentiometry at T = 298.15 K and 0.10 ≤ I/M ≤ 1.00 in NaCl(aq) (in NaNO3(aq) only for Al3+/GTZ S95 and Al3+/Gluc- acid systems). For Al3+/Cit3-, Al3+/Lac- and Al3+/GTZ AN1694- systems, the investigations were also carried out at 283.15 ≤ T/K ≤ 318.15. The dependence of the thermodynamic parameters on ionic strength and temperature was modelled with a Debye-Hückel type equation. Different speciation schemes of Al3+/Lz- systems were obtained, including protonated, simple metal-ligand, polynuclear and hydrolytic mixed species. At I → 0 M and T = 298.15 K the stability trend for the AlL(3-z) species is: 14.28 ± 0.02, 13.99 ± 0.03, 10.16 ± 0.03, 3.16 ± 0.08, 2.84 ± 0.10 for GTZ S95, GTZ AN169, Cit3-, Gluc- and Lac-, respectively. From the investigations at different temperatures, it results that the entropic contribution is the driving force of the reactions. The sequestering ability of the ligands towards Al3+ was investigated determining the pL0.5 parameter at different experimental conditions, finding the following trend: Cit3- ¼ Gluc- > GTZ S954- > GTZ AN1694- > Lac- for the organic ligands, and pL0.5: F- ¼ CO32- > H2SiO42- for the inorganic ones.

The cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms.

BACKGROUND: The need to provide quality and equitable health services and protect populations from impoverishing health care costs has pushed universal health coverage (UHC) to the top of global health policy agenda. In many developing countries where the majority of the population works in the informal sector, there are critical debates over the best financing mechanisms to progress towards UHC. In Kenya, government health policy has prioritized contributory financing strategy (social health insurance) as the main financing mechanism for UHC. However, there are currently no studies that have assessed the cost of either social health insurance (SHI) as the contributory approach or an alternative financing mechanism involving non-contributory (general tax funding) approaches to UHC in Kenya. The aim of this study was to critically assess the financial requirements of both contributory and non-contributory mechanisms to financing UHC in Kenya in the context of large informal sector populations. METHODS: SimIns Basic® model, Version 2.1, 2008 (WHO/GTZ), was used to assess the feasibility of UHC in Kenya and provide estimates of financial resource needs for UHC over a 17-year period (2013-2030). Data sources included review of national and international literature on inflation, demography, macro-economy, health insurance, health services unit costs and utilization rates. The data were triangulated across geographic regions for accuracy and integrity of the simulation. SimIns models for 10 years only so data from the final year of the model was used to project for another 7 years. The 17-year period was necessary because the Government of Kenya aims to achieve UHC by 2030. RESULTS AND CONCLUSIONS: The results show that SHI is financially sustainable (Sustainability in this study is used to mean that expenditure does not outstrip revenue.) (revenues and expenditure match) within the first five years of implementation, but it becomes less sustainable with time. Modelling for a non-contributory scenario, on the other hand, showed greater sustainability both in the short- and long-term. The financial resource requirements for universal access to health care through general government revenue are compared with a contributory health insurance scheme approach. Although both funding options would require considerable government subsidies, given the magnitude of the informal sector in Kenya and their limited financial capacity, a tax-funded system would be less costly and more sustainable in the long-term than an insurance scheme approach. However, more innovative financing for health care as well as giving the health sector higher priority in government expenditure will be required to make the non-contributory financing mechanism more sustainable.

GTZ: a fast compression and cloud transmission tool optimized for FASTQ files.

BACKGROUND: The dramatic development of DNA sequencing technology is generating real big data, craving for more storage and bandwidth. To speed up data sharing and bring data to computing resource faster and cheaper, it is necessary to develop a compression tool than can support efficient compression and transmission of sequencing data onto the cloud storage. RESULTS: This paper presents GTZ, a compression and transmission tool, optimized for FASTQ files. As a reference-free lossless FASTQ compressor, GTZ treats different lines of FASTQ separately, utilizes adaptive context modelling to estimate their characteristic probabilities, and compresses data blocks with arithmetic coding. GTZ can also be used to compress multiple files or directories at once. Furthermore, as a tool to be used in the cloud computing era, it is capable of saving compressed data locally or transmitting data directly into cloud by choice. We evaluated the performance of GTZ on some diverse FASTQ benchmarks. Results show that in most cases, it outperforms many other tools in terms of the compression ratio, speed and stability. CONCLUSIONS: GTZ is a tool that enables efficient lossless FASTQ data compression and simultaneous data transmission onto to cloud. It emerges as a useful tool for NGS data storage and transmission in the cloud environment. GTZ is freely available online at: https://github.com/Genetalks/gtz .

Preparation of 13X from Waste Quartz and Photocatalytic Reaction of Methyl Orange on TiO2/ZSM-5, 13X and Y-Zeolite.

TiO2 photocatalytic reactions not only remove a variety of organic pollutants via complete mineralization, but also destroy the bacterial cell wall and cell membrane, thus playing an important bactericidal role. However, the post-filtration procedures to separate nanometer-levels of TiO2 and the gradual inactivity of photocatalyst during continuous use are defects that limit its application. In this case, we propose loading TiO2 on zeolite for easy separation and 13X is considered as a promising one. In our study, 13X-zeolite was prepared by a hydrothermal method and the source of Si was extracted from waste quartz sand. For comparison, commercial zeolite with different microporous and mesoporous diameters (ZSM-5 and Y-zeolites) were also used as TiO2 supports. The pore size of the three kinds of zeolites are as follows: Y-zeolite > 13X > ZSM-5. Different TiO2 loading content over ZSM-5, 13X and Y-zeolite were prepared by the sol-gel method. XRD, FTIR, BET, UV-vis, TGA and SEM were used for investigation of material characteristics. In addition, the efficiencies of mineralization and photodegradation were studied in this paper. The effects of the loading ratio of TiO2 over zeolites, initial pH, and concentration on photocatalytic performance are investigated. The relationship between best loading content of TiO2 and pore size of the zeolite was studied. The possible roles of the ZSM-5, 13X-zeolites and Y-zeolites support on the reactions and the possible mechanisms of effects were also explored. The best loading content of TiO2 over ZSM-5, 13X and Y-zeolite was found to be 50 wt%, 12.5 wt% and 7 wt%, respectively. The optimum pH condition is 3 with TiO2 over ZSM-5, 13X-zeolites and Y-zeolites. The results showed that the degradation and mineralization efficiency of 12.5 wt%GT13X (TiO2 over 13X) after 90 min irradiation reached 57.9% and 22.0%, which was better than that of 7 wt%GTYZ (TiO2 over Y-zeolites) while much lower than that of 50 wt%GTZ (TiO2 over ZSM-5). The materials were recycled four times while the degradation was remained at a higher level.

Glitazone Treatment and Incidence of Parkinson's Disease among People with Diabetes: A Retrospective Cohort Study.

BACKGROUND: Recent in vitro and animal experiments suggest that peroxisome proliferation-activated receptor gamma (PPARÉ£) agonist medications, such as antidiabetic glitazone (GTZ) drugs, are neuroprotective in models of Parkinson's disease (PD). These findings have not been tested in humans. We hypothesized that individuals prescribed GTZ drugs would have a lower incidence of PD compared to individuals prescribed other treatments for diabetes. METHODS AND FINDINGS: Using primary care data from the United Kingdom Clinical Practice Research Datalink (CPRD), we conducted a retrospective cohort study in which individuals with diabetes who were newly prescribed GTZ (GTZ-exposed group) were matched by age, sex, practice, and diabetes treatment stage with up to five individuals prescribed other diabetes treatments (other antidiabetic drug-exposed group). Patients were followed up from 1999 until the first recording of a PD diagnosis, end of observation in the database, or end of the study (1 August 2013). An incidence rate ratio (IRR) was calculated using conditional Poisson regression, adjusted for possible confounders. 44,597 GTZ exposed individuals were matched to 120,373 other antidiabetic users. 175 GTZ-exposed individuals were diagnosed with PD compared to 517 individuals in the other antidiabetic drug-exposed group. The incidence rate (IR) of PD in the GTZ-exposed group was 6.4 per 10,000 patient years compared with 8.8 per 10,000 patient years in those prescribed other antidiabetic treatments (IRR 0.72, 95% confidence interval [CI] 0.60-0.87). Adjustments for potential confounding variables, including smoking, other medications, head injury, and disease severity, had no material impact (fully adjusted IRR 0.75, 0.59-0.94). The risk was reduced in those with current GTZ prescriptions (current GTZ-exposed IRR 0.59, 0.46-0.77) but not reduced among those with past prescriptions (past GTZ-exposed IRR 0.85, 0.65-1.10). Our study only included patients with diabetes who did not have a PD diagnosis when they were first prescribed GTZ, and thus, it cannot establish whether GTZ use prevents or slows the progression of PD. CONCLUSIONS: In patients with diabetes, a current prescription for GTZ is associated with a reduction in incidence of PD. This suggests PPAR gamma pathways may be a fruitful drug target in PD.

A novel rGR-TiO2-ZrO2 composite nanosheet for capturing phosphopeptides from biosamples.

A novel rGR-TiO2-ZrO2 (rGTZ) composite nanosheet comprising graphene oxides, tetrabutyl titanate, and zirconium(iv) isopropoxide was synthesized using a simple sol-gel method and hydrothermal treatment. The excellent surface area of graphene and the specificity of TiO2 and ZrO2 toward phosphopeptides were integrated to form a composite with a high number of specific sites for the capture of phosphopeptides from complex biosamples. The average diameter of the nanoparticles that were loaded onto the flat graphene surface was 100 nm, according to a TEM analysis. The adsorption behaviors of the materials were evaluated using the Langmuir model equation, and the Qmax values of the commercial TiO2, GTZ, and rGTZ were calculated to be 373.1 mg g-1, 250.0 mg g-1 and 490.2 mg g-1. Beta-casein was applied as a standard protein to optimize the conditions for phosphopeptide enrichment. Different materials (GTZ and commercial TiO2) were used to demonstrate the superiority of the rGTZ composite nanosheet for capturing phosphopeptides from tryptic digests of ß-casein under the optimized conditions. Various complex samples (α-casein, mixtures of ß-casein and bovine serum albumin, which were used as examples of semi-complex samples, non-fat milk, and mouse organs) were exploited to evaluate the capabilities and efficiency of the rGTZ nanosheet composite. 1980 phosphopeptides from 1769 proteins from mouse brain and 577 phosphopeptides from 1267 proteins from mouse liver were identified by their enrichment in mouse brain and liver using rGTZ nanosheet composites.

Regional HIV knowledge hubs: a new approach by the health sector to transform knowledge into practice.

This study aims to introduce the knowledge hub (KH) as an initiative to facilitate transformation of knowledge into practice and to highlight the activity and limitations with this new policy. The study was conducted through a review of articles; expert views in this field were sought for further information. Regional human immunodeficiency virus (HIV) KHs were developed by the World Health Organization and GTZ. A series of activities including capacity building, development of training models, technical assistance, and application of studies are provided through these hubs. However, financial limitations are the main obstacle in achieving these aims. This piece of work introduces these HIV hubs in order to help countries, particularly developing countries, provide the support needed to fight the progression of HIV.

Inside the black box: modelling health care financing reform in data-poor contexts.

Modelling the likely financial resource requirements and potential sources of revenue for health system reform options is of great potential value to policy-makers. Models provide an indication of the financial feasibility and sustainability of such reforms and highlight the implications of alternative reform paths. There has been increasing use of financial models of health sector reform in recent years, particularly since the development of user-friendly software such as SimIns, which was developed by the World Health Organization (WHO) and Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ). This paper outlines the process of developing country-specific spreadsheet-based models to explore the financial resource requirements of health system reform options in South Africa and Tanzania. Building one's own model, although time consuming, allows for greater flexibility and forces the analysts to give careful consideration to the assumptions underlying the model. The core variables in our models are: population, health service utilization rates and unit costs. The paper outlines the types of disaggregation of these variables, the range of possible data sources, key challenges with securing accurate data for each variable, and relevant evidence on which to base key assumptions, and how we went about addressing these challenges. We also briefly review how to model the revenue-generating potential of alternative sources of health care financing. The intention of the paper is to provide guidance for analysts who wish to develop their own models, and to illustrate, with reference to the South African and Tanzanian modelling experience, how one has to adapt to data constraints and context-specific modelling requirements.

Relative effect of glyphosate on glyphosate-tolerant maize rhizobacterial communities is not altered by soil properties.

The rhizobacterial composition varies according to the soil properties. To test if the effect of herbicides on the rhizobacterial communities of genetically modified NK603 glyphosate-tolerant maize varies according to different soil locations, a comparison was made between the effects of glyphosate (Roundup Plus), a post-emergence applied herbicide, and a pre-emergence applied herbicide (GTZ) versus untreated soil. The potential effect was monitored by direct amplification, cloning, and sequencing of the soil DNA encoding 16S rRNA, and high-throughput DNA pyrosequencing of the bacterial DNA coding for the 16S rRNA hypervariable V6 region. The results obtained using three different methods to analyze the herbicide effect on the rhizobacterial communities of genetically modified NK603 maize were comparable to those previously obtained when glyphosate-tolerant maize was grown in soil with different characteristics. Both herbicides decreased the bacterial diversity in the rhizosphere, with Actinobacteria being the taxonomic group most affected. The results suggest that both herbicides affected the structure of the maize rhizobacterial community, but glyphosate was environmentally less aggressive.