Pediatric HIV care and treatment services in Tanzania: implications for survival.

BACKGROUND: Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. METHODS: The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. RESULTS: A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0-14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2-3% of children were positive for TB, and 2-4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26-35), 43% (40-47), 52% (49-55) and 61% (58-64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10-15% higher survival over time. CONCLUSIONS: Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered.

Measurement of the Inelastic Proton-Proton Cross Section at sqrt[s]=13 TeV with the ATLAS Detector at the LHC.

This Letter presents a measurement of the inelastic proton-proton cross section using 60 µb^{-1} of pp collisions at a center-of-mass energy sqrt[s] of 13 TeV with the ATLAS detector at the LHC. Inelastic interactions are selected using rings of plastic scintillators in the forward region (2.07<|η|<3.86) of the detector. A cross section of 68.1±1.4 mb is measured in the fiducial region ξ=M_{X}^{2}/s>10^{-6}, where M_{X} is the larger invariant mass of the two hadronic systems separated by the largest rapidity gap in the event. In this ξ range the scintillators are highly efficient. For diffractive events this corresponds to cases where at least one proton dissociates to a system with M_{X}>13 GeV. The measured cross section is compared with a range of theoretical predictions. When extrapolated to the full phase space, a cross section of 78.1±2.9 mb is measured, consistent with the inelastic cross section increasing with center-of-mass energy.

Measurement of the ZZ Production Cross Section in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector.

The ZZ production cross section in proton-proton collisions at 13 TeV center-of-mass energy is measured using 3.2 fb^{-1} of data recorded with the ATLAS detector at the Large Hadron Collider. The considered Z boson candidates decay to an electron or muon pair of mass 66-116 GeV. The cross section is measured in a fiducial phase space reflecting the detector acceptance. It is also extrapolated to a total phase space for Z bosons in the same mass range and of all decay modes, giving 16.7_{-2.0}^{+2.2}(stat)+0.9/-0.7(syst)+1.0/-0.7(lumi) pb. The results agree with standard model predictions.

Observation of Long-Range Elliptic Azimuthal Anisotropies in sqrt[s]=13 and 2.76 TeV pp Collisions with the ATLAS Detector.

ATLAS has measured two-particle correlations as a function of the relative azimuthal angle, Δϕ, and pseudorapidity, Δη, in sqrt[s]=13 and 2.76 TeV pp collisions at the LHC using charged particles measured in the pseudorapidity interval |η|<2.5. The correlation functions evaluated in different intervals of measured charged-particle multiplicity show a multiplicity-dependent enhancement at Δϕ∼0 that extends over a wide range of Δη, which has been referred to as the "ridge." Per-trigger-particle yields, Y(Δϕ), are measured over 2<|Δη|<5. For both collision energies, the Y(Δϕ) distribution in all multiplicity intervals is found to be consistent with a linear combination of the per-trigger-particle yields measured in collisions with less than 20 reconstructed tracks, and a constant combinatoric contribution modulated by cos(2Δϕ). The fitted Fourier coefficient, v_{2,2}, exhibits factorization, suggesting that the ridge results from per-event cos(2ϕ) modulation of the single-particle distribution with Fourier coefficients v_{2}. The v_{2} values are presented as a function of multiplicity and transverse momentum. They are found to be approximately constant as a function of multiplicity and to have a p_{T} dependence similar to that measured in p+Pb and Pb+Pb collisions. The v_{2} values in the 13 and 2.76 TeV data are consistent within uncertainties. These results suggest that the ridge in pp collisions arises from the same or similar underlying physics as observed in p+Pb collisions, and that the dynamics responsible for the ridge has no strong sqrt[s] dependence.

Search for Higgs and Z Boson Decays to ϕγ with the ATLAS Detector.

A search for the decays of the Higgs and Z bosons to a ϕ meson and a photon is performed with a pp collision data sample corresponding to an integrated luminosity of 2.7 fb^{-1} collected at sqrt[s]=13 TeV with the ATLAS detector at the LHC. No significant excess of events is observed above the background, and 95% confidence level upper limits on the branching fractions of the Higgs and Z boson decays to ϕγ of 1.4×10^{-3} and 8.3×10^{-6}, respectively, are obtained.

Determination of the Ratio of b-Quark Fragmentation Fractions f(s)/f(d) in pp Collisions at √s=7 TeV with the ATLAS Detector.

With an integrated luminosity of 2.47 fb(-1) recorded by the ATLAS experiment at the LHC, the exclusive decays B(s)(0)→J/ψϕ and B(d)(0)→J/ψK(*0) of B mesons produced in pp collisions at √s=7 TeV are used to determine the ratio of fragmentation fractions f(s)/f(d). From the observed B(s)(0)→J/ψϕ and B(d)(0)→J/ψK(*0) yields, the quantity (f(s)/f(d))[B(B(s)(0)→J/ψϕ)/B(B(d)(0)→J/ψK(*0))] is measured to be 0.199±0.004(stat)±0.008(syst). Using a recent theory prediction for [B(B(s)(0)→J/ψϕ)/B(B(d)(0)→J/ψK(*0))] yields (f(s)/f(d))=0.240±0.004(stat)±0.010(syst)±0.017(th). This result is based on a new approach that provides a significant improvement of the world average.

Pegvisomant and cabergoline combination therapy in acromegaly.

Combination with cabergoline may offer additional benefits to acromegalic patients on pegvisomant monotherapy. We evaluated the safety and efficacy profile of this combination and investigated the determinants of response. An observational, retrospective, cross-sectional study. Fourteen acromegalic patients (9 females), who were partially resistant to somatostatin analogs and on pegvisomant monotherapy. Cabergoline was added because of the presence of persistent mildly increased IGF-I. The mean follow-up time was 18.3 ± 10.4 months. The efficacy and safety profile was assessed. The influence of clinical and biochemical characteristics on treatment efficacy was studied. IGF-I levels returned to normal in 4 patients (28%) at the end of the study. In addition, some decline in IGF-I levels was observed in a further 5 patients. The % IGF-I decreased from 158 ± 64% to 124 ± 44% (p = 0.001). The average change in IGF-I was -18 ± 27% (range -67 to +24%). Lower baseline IGF-I (p = 0.007), female gender (p = 0.013), lower body weight (p = 0.031), and higher prolactin (PRL) levels (p = 0.007) were associated with a better response to combination therapy. There were no significant severe adverse events. Significant tumour shrinkage was observed in 1 patient. Combination therapy with pegvisomant and cabergoline could provide better control of IGF-I in some patients with acromegaly. Baseline IGF-I levels, female gender, body weight, and PRL levels affect the response to this combination therapy.

Role of systemic inflammatory factors in gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with peptide receptor radionuclide therapy (PRRT): From biology to theragnosis.

AIM: Systemic inflammatory factors have been validated as indicators of ongoing systemic inflammation that could be predictive markers of poor prognosis for oncological outcomes. However, the prognostic impact of systemic inflammation markers is unknown in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with peptide receptor radionuclide therapy (PRRT). METHODS: We conducted an observational, retrospective, multicentric study of 40 patients with GEP or unknown origin NETs treated with PRRT between 2016 and 2020. The systemic inflammatory markers were calculated as follows: neutrophil to lymphocyte ratio (NLR)=neutrophil count/lymphocyte count, monocyte to lymphocyte ratio (MLR)=monocyte count/lymphocyte count, platelet to lymphocyte ratio (PLR)=platelet count/lymphocyte count, albumin to lymphocyte ratio (ALR)=albumin levels/lymphocyte count and derived Neutrophil to Lymphocyte ratio (dNLR)=neutrophil count/(leucocytes count - neutrophils count). Baseline analysis and after the second dose were used for the calculation of different ratios. RESULTS: The median age was 63 years (range 41-85), 55% were male. The baseline cut-off values for NLR were 2.61, for MLR 0.31, for PLR 110.14, for ALR 2.39 and for dNLR 1.71. The cut-off values after the 2° dose were, for NLR 2.3, for MLR 0.3, for PLR 131.61, ALR 4.16, and dNLR 1.48. Median progression-free survival (PFS) was 21.7 months (95% CI 10.7-32.8 months) and overall survival (OS) was 32.1 months (95% CI 19.6-44.7 months), PFS was shorter in patients with elevated NLR (p=0.001), ALR (0.03), and dNLR (p=0.001) in baseline analysis. DCR was 81% and ORR 18%. CONCLUSIONS: In GEP or unknown origin NETs treated with PRRT, we have identified the predictive and prognostic impact of baseline systemic inflammatory factors.

Reduced adipogenic gene expression in fibroblasts from a patient with type 2 congenital generalized lipodystrophy.

AIMS: Beradinelli-Seip congenital generalized lipodystrophy is a rare autosomal recessive disorder characterized by near-complete absence of adipose tissue, Herculean appearance, insulin resistance, hypoleptinaemia and diabetes mellitus. The aim of this study was to investigate the in vitro effects of pioglitazone on the expression of genes involved in adipogenesis in fibroblasts from a patient with this condition due to a seipin mutation. METHODS: Primary cultures of fibroblasts from the skin of the patient were obtained. Fibroblasts were treated with classic adipose differentiation medium, with and without pioglitazone. Several adipogenes were evaluated by real-time reverse transcriptase-polymerase chain reaction and western blotting. Intracellular localization of prelamin A was studied by immunofluorescence microscopy. RESULTS: The expression of the adipogenic genes PPARG, LPL, LEP and SLC2A4 was reduced in lipodystrophic fibroblasts, while treatment with pioglitazone increased the expression of these genes. Moreover, and unexpectedly, we found an accumulation of farnesylated prelamin A in lipodystrophic fibroblasts. CONCLUSIONS: The process of adipocyte differentiation is compromised in patients with Beradinelli-Seip congenital lipodystrophy owing to diminished expression of the regulatory genes involved, which pioglitazone treatment partially rescues. Prelamin A accumulation establishes a link with other types of familial lipodystrophies, as familial partial lipodystrophy.

Performance of algorithms that reconstruct missing transverse momentum in [Formula: see text]= 8 TeV proton-proton collisions in the ATLAS detector.

The reconstruction and calibration algorithms used to calculate missing transverse momentum ([Formula: see text] ) with the ATLAS detector exploit energy deposits in the calorimeter and tracks reconstructed in the inner detector as well as the muon spectrometer. Various strategies are used to suppress effects arising from additional proton-proton interactions, called pileup, concurrent with the hard-scatter processes. Tracking information is used to distinguish contributions from the pileup interactions using their vertex separation along the beam axis. The performance of the [Formula: see text] reconstruction algorithms, especially with respect to the amount of pileup, is evaluated using data collected in proton-proton collisions at a centre-of-mass energy of 8 [Formula: see text] during 2012, and results are shown for a data sample corresponding to an integrated luminosity of [Formula: see text]. The simulation and modelling of [Formula: see text]  in events containing a Z boson decaying to two charged leptons (electrons or muons) or a W boson decaying to a charged lepton and a neutrino are compared to data. The acceptance for different event topologies, with and without high transverse momentum neutrinos, is shown for a range of threshold criteria for [Formula: see text] , and estimates of the systematic uncertainties in the [Formula: see text]  measurements are presented.

Reconstruction of primary vertices at the ATLAS experiment in Run 1 proton-proton collisions at the LHC.

This paper presents the method and performance of primary vertex reconstruction in proton-proton collision data recorded by the ATLAS experiment during Run 1 of the LHC. The studies presented focus on data taken during 2012 at a centre-of-mass energy of [Formula: see text] TeV. The performance has been measured as a function of the number of interactions per bunch crossing over a wide range, from one to seventy. The measurement of the position and size of the luminous region and its use as a constraint to improve the primary vertex resolution are discussed. A longitudinal vertex position resolution of about [Formula: see text] is achieved for events with high multiplicity of reconstructed tracks. The transverse position resolution is better than [Formula: see text] and is dominated by the precision on the size of the luminous region. An analytical model is proposed to describe the primary vertex reconstruction efficiency as a function of the number of interactions per bunch crossing and of the longitudinal size of the luminous region. Agreement between the data and the predictions of this model is better than 3% up to seventy interactions per bunch crossing.

Topological cell clustering in the ATLAS calorimeters and its performance in LHC Run 1.

The reconstruction of the signal from hadrons and jets emerging from the proton-proton collisions at the Large Hadron Collider (LHC) and entering the ATLAS calorimeters is based on a three-dimensional topological clustering of individual calorimeter cell signals. The cluster formation follows cell signal-significance patterns generated by electromagnetic and hadronic showers. In this, the clustering algorithm implicitly performs a topological noise suppression by removing cells with insignificant signals which are not in close proximity to cells with significant signals. The resulting topological cell clusters have shape and location information, which is exploited to apply a local energy calibration and corrections depending on the nature of the cluster. Topological cell clustering is established as a well-performing calorimeter signal definition for jet and missing transverse momentum reconstruction in ATLAS.

Search for triboson [Formula: see text] production in pp collisions at [Formula: see text] [Formula: see text] with the ATLAS detector.

This paper reports a search for triboson [Formula: see text] production in two decay channels ([Formula: see text] and [Formula: see text] with [Formula: see text]) in proton-proton collision data corresponding to an integrated luminosity of 20.3 [Formula: see text] at a centre-of-mass energy of 8 [Formula: see text] with the ATLAS detector at the Large Hadron Collider. Events with exactly three charged leptons, or two leptons with the same electric charge in association with two jets, are selected. The total number of events observed in data is consistent with the Standard Model (SM) predictions. The observed 95% confidence level upper limit on the SM [Formula: see text] production cross section is found to be 730 fb with an expected limit of 560 fb in the absence of SM [Formula: see text] production. Limits are also set on WWWW anomalous quartic gauge couplings.

A measurement of the calorimeter response to single hadrons and determination of the jet energy scale uncertainty using LHC Run-1 pp-collision data with the ATLAS detector.

A measurement of the calorimeter response to isolated charged hadrons in the ATLAS detector at the LHC is presented. This measurement is performed with 3.2 nb[Formula: see text] of proton-proton collision data at [Formula: see text] [Formula: see text] from 2010 and 0.1 nb[Formula: see text] of data at [Formula: see text] [Formula: see text] from 2012. A number of aspects of the calorimeter response to isolated hadrons are explored. After accounting for energy deposited by neutral particles, there is a 5% discrepancy in the modelling, using various sets of Geant4 hadronic physics models, of the calorimeter response to isolated charged hadrons in the central calorimeter region. The description of the response to anti-protons at low momenta is found to be improved with respect to previous analyses. The electromagnetic and hadronic calorimeters are also examined separately, and the detector simulation is found to describe the response in the hadronic calorimeter well. The jet energy scale uncertainty and correlations in scale between jets of different momenta and pseudorapidity are derived based on these studies. The uncertainty is 2-5% for jets with transverse momenta above 2 [Formula: see text], where this method provides the jet energy scale uncertainty for ATLAS.

Measurement of the [Formula: see text] and [Formula: see text] production cross sections in multilepton final states using 3.2 fb[Formula: see text] of [Formula: see text] collisions at [Formula: see text] = 13 TeV with the ATLAS detector.

A measurement of the [Formula: see text] and [Formula: see text] production cross sections in final states with either two same-charge muons, or three or four leptons (electrons or muons) is presented. The analysis uses a data sample of proton-proton collisions at [Formula: see text] TeV recorded with the ATLAS detector at the Large Hadron Collider in 2015, corresponding to a total integrated luminosity of 3.2 fb[Formula: see text]. The inclusive cross sections are extracted using likelihood fits to signal and control regions, resulting in [Formula: see text] pb and [Formula: see text] pb, in agreement with the Standard Model predictions.

Search for lepton-flavour-violating decays of the Higgs and Z bosons with the ATLAS detector.

Direct searches for lepton flavour violation in decays of the Higgs and Z bosons with the ATLAS detector at the LHC are presented. The following three decays are considered: [Formula: see text], [Formula: see text], and [Formula: see text]. The searches are based on the data sample of proton-proton collisions collected by the ATLAS detector corresponding to an integrated luminosity of 20.3 [Formula: see text] at a centre-of-mass energy of [Formula: see text] TeV. No significant excess is observed, and upper limits on the lepton-flavour-violating branching ratios are set at the 95[Formula: see text] confidence level: Br[Formula: see text], Br[Formula: see text], and Br[Formula: see text].

Identification of boosted, hadronically decaying W bosons and comparisons with ATLAS data taken at [Formula: see text] TeV.

This paper reports a detailed study of techniques for identifying boosted, hadronically decaying W bosons using 20.3 fb[Formula: see text] of proton-proton collision data collected by the ATLAS detector at the LHC at a centre-of-mass energy [Formula: see text]. A range of techniques for optimising the signal jet mass resolution are combined with various jet substructure variables. The results of these studies in Monte Carlo simulations show that a simple pairwise combination of groomed jet mass and one substructure variable can provide a 50 % efficiency for identifying W bosons with transverse momenta larger than 200 GeV while maintaining multijet background efficiencies of 2-4 % for jets with the same transverse momentum. These signal and background efficiencies are confirmed in data for a selection of tagging techniques.

Measurements of top-quark pair differential cross-sections in the lepton+jets channel in pp collisions at [Formula: see text] using the ATLAS detector.

Measurements of normalized differential cross-sections of top-quark pair production are presented as a function of the top-quark, [Formula: see text] system and event-level kinematic observables in proton-proton collisions at a centre-of-mass energy of [Formula: see text]. The observables have been chosen to emphasize the [Formula: see text] production process and to be sensitive to effects of initial- and final-state radiation, to the different parton distribution functions, and to non-resonant processes and higher-order corrections. The dataset corresponds to an integrated luminosity of 20.3 fb[Formula: see text], recorded in 2012 with the ATLAS detector at the CERN Large Hadron Collider. Events are selected in the lepton+jets channel, requiring exactly one charged lepton and at least four jets with at least two of the jets tagged as originating from a b-quark. The measured spectra are corrected for detector effects and are compared to several Monte Carlo simulations. The results are in fair agreement with the predictions over a wide kinematic range. Nevertheless, most generators predict a harder top-quark transverse momentum distribution at high values than what is observed in the data. Predictions beyond NLO accuracy improve the agreement with data at high top-quark transverse momenta. Using the current settings and parton distribution functions, the rapidity distributions are not well modelled by any generator under consideration. However, the level of agreement is improved when more recent sets of parton distribution functions are used.

Search for squarks and gluinos in final states with jets and missing transverse momentum at [Formula: see text] =13 [Formula: see text]with the ATLAS detector.

A search for squarks and gluinos in final states containing hadronic jets, missing transverse momentum but no electrons or muons is presented. The data were recorded in 2015 by the ATLAS experiment in [Formula: see text] proton-proton collisions at the Large Hadron Collider. No excess above the Standard Model background expectation was observed in 3.2 [Formula: see text] of analyzed data. Results are interpreted within simplified models that assume R-parity is conserved and the neutralino is the lightest supersymmetric particle. An exclusion limit at the 95 % confidence level on the mass of the gluino is set at 1.51 [Formula: see text] for a simplified model incorporating only a gluino octet and the lightest neutralino, assuming the lightest neutralino is massless. For a simplified model involving the strong production of mass-degenerate first- and second-generation squarks, squark masses below 1.03 [Formula: see text] are excluded for a massless lightest neutralino. These limits substantially extend the region of supersymmetric parameter space excluded by previous measurements with the ATLAS detector.

Search for squarks and gluinos in events with hadronically decaying tau leptons, jets and missing transverse momentum in proton-proton collisions at [Formula: see text] TeV recorded with the ATLAS detector.

A search for supersymmetry in events with large missing transverse momentum, jets, and at least one hadronically decaying tau lepton has been performed using 3.2 fb[Formula: see text] of proton-proton collision data at [Formula: see text] recorded by the ATLAS detector at the Large Hadron Collider in 2015. Two exclusive final states are considered, with either exactly one or at least two tau leptons. No excess over the Standard Model prediction is observed in the data. Results are interpreted in the context of gauge-mediated supersymmetry breaking and a simplified model of gluino pair production with tau-rich cascade decays, substantially improving on previous limits. In the GMSB model considered, supersymmetry-breaking scale ([Formula: see text]) values below [Formula: see text] are excluded at the 95% confidence level, corresponding to gluino masses below [Formula: see text]. For large values of [Formula: see text], values of [Formula: see text] up to [Formula: see text] and gluino masses up to [Formula: see text] are excluded. In the simplified model, gluino masses are excluded up to [Formula: see text] for neutralino masses around [Formula: see text]. Neutralino masses below [Formula: see text] are excluded for all gluino masses between 800 and [Formula: see text], while the strongest exclusion of [Formula: see text] is achieved for gluino masses around [Formula: see text].