Large carnivores are amongst the most susceptible species to human activities, and human-modified environments pose a threat to carnivore conservation. Wolves (Canis lupus Linnaeus, 1758) in the ...central Apennines, Italy, have coexisted with humans since historic times and represent a good case study to assess their spatiotemporal response to anthropogenic factors. From 2008 to 2010, we investigated the spatial behavior of wolves (seven wolves in five packs and six floaters) in the Abruzzo Lazio and Molise National Park. Orographically corrected annual home ranges of resident wolf packs, estimated through the Brownian bridge movement model, averaged 104 ± 24 km
2
(mean ± SD), whereas floaters used two- to fourfold larger areas (293.8–408.7 km
2
). We did not detect any seasonal effect on home range size, but home ranges were larger during the night and in areas of greater road density, especially during summer. By estimating core areas through an individual-based approach, we also revealed a habitat-mediated response to human presence and activity, as resident wolves preferentially established core areas at greater elevation and in the more forested and inaccessible portions of the home range.
Understanding large carnivores’ behavioural adaptations to habitat modifications is critical for their persistence in human‐modified environments. Based on 10 Global Positioning System‐collared ...wolves in a protected area of central Italy, we investigated wolf responses to anthropogenic features such as roads and settlements by using Step and Resource Selection Functions. We revealed that responses by wolves to anthropogenic features varied according to behavioural state (travelling vs. resting) and social affiliation (pack members vs. floaters), while accounting for seasonal and circadian effects. During summer, pack members strongly avoided roads and settlements throughout all day, both when travelling and resting, and complemented this response by selecting forested areas and shrublands. Conversely, during fall and winter, pack members relaxed the avoidance towards anthropogenic features by travelling closer to main roads and settlements, but they still selected resting sites farther from anthropogenic features and located them in denser cover and along steeper slopes. Compared to pack members, floaters, when travelling, showed a weaker avoidance of main roads and settlements and did not show any selection pattern towards environmental variables. When resting, contrary to pack members, floaters selected sites closer to main roads and settlements, even though these were still located along denser cover and steeper slopes. Our findings suggest that wolves living in human‐modified landscapes adapt behaviourally to the spatial and temporal distribution of perceived interference by humans and that their response is complementary to the expected seasonal and circadian variation in human activity. These adaptations appear to be aided by the selection of habitat features that enhance security and allow segregation from humans. Maintenance of such habitat characteristics appears of critical importance to ensure the functionality of behavioural adaptations by wolves living in human‐modified landscapes.
Understanding large carnivores’ behavioural adaptations to habitat modifications is critical for their persistence in human‐modified environments. Based on 10 GPS‐collared wolves in central Italy, we investigated wolf responses to roads and settlements by using Step and Resource Selection Functions. We revealed that responses by wolves to anthropogenic features varied according to behavioural state (travelling vs. resting) and social affiliation (pack members vs. floaters), while accounting for seasonal, circadian and habitat‐mediated effects. Our findings suggest that wolves living in human‐modified landscapes adapt to the spatial and temporal distribution of perceived interference by humans and that their response is complementary to the expected seasonal and circadian variation in human activity. These adaptations appear to be aided by the selection of habitat features that allow segregation from humans. Maintenance of such habitat characteristics appears of critical importance to ensure the functionality of behavioural adaptations by wolves living in human‐modified landscapes.
Tuberculosis (TB) represents the ninth leading cause of death worldwide. In 2016 are estimated 1.3 million TB deaths among HIV negative people and an additional 374,000 deaths among HIV positive ...people. In 2016 are estimated 1.4 million new cases of TB in people living with HIV (PLHIV), 74% of whom were living in Africa. In light of these data, the reduction of mortality caused by TB in PLHIV is strongly required specially in low-income countries as Mozambique. According to international guidelines, the initial TB screening in HIV+ patients should be done with the four symptoms screening (4SS: fever, current cough, night sweats and weight loss). The diagnostic test more used in resource-limited countries is smear microscopy (SMEAR). World Health Organization (WHO) recommended Lateral Flow urine LipoArabinoMannan assay (LF-LAM) in immunocompromised patients; in 2010 WHO endorsed the use of Xpert Mycobacterium Tuberculosis/Rifampicin (MTB/RIF) test for rapid TB diagnosis but the assay is not used as screening test in all HIV+ patients irrespectively of symptoms due to cost and logistical barriers. The paper aims to evaluate the cost-effectiveness of three screening protocols: standard (4SS and SMEAR in positive patients to 4SS); MTB/RIF; LF-LAM / MTB/RIF.
We developed a model to assess the cost-effectiveness of the MTB/RIF protocol versus the common standard and LF-LAM / MTB/RIF protocol. The model considered a sample of 1,000 HIV+ antiretroviral treatment naïve patients in Mozambique. We evaluated disability-adjusted life year (DALY) averted for each protocol, cost per DALY, and incremental cost-effectiveness ratio (ICER), over 1-year, assuming a national healthcare system perspective. The model considered the delayed diagnosis as the time elapsed between a false negative test and the diagnosis and treatment of TB. Additional health system organization delay is defined as the time interval between positive test and treatment initiation caused by a delay in the delivery of results due organization of services. We conducted a sensitivity analysis on more relevant variables.
The MTB/RIF protocol was cost-effective as compared to the standard protocol with an ICER of $56.54 per DALY saved. In a cohort of 1,000 patients MTB/RIF and LF-LAM / MTB/RIF protocol generated 1,281 and 1,254 DALY's saved respectively, with a difference of 174 and 147 DALY respect to the standard protocol. The total cost of MTB/RIF protocol was lower ($92,263) than the standard ($147,226) and the LF-LAM / MTB/RIF ($113,196). Therefore, the cost per DALY saved including new infections due to delayed diagnosis with the standard protocol was $79.06, about 5 fold higher than MTB/RIF and LF-LAM / MTB/RIF protocols. The cost of additional TB infections due to delays in diagnosis plus health system delay seemed the more relevant costs. The low sensibility and sensitivity of the standard protocol led to a high number of false negatives, thus delayed TB diagnoses and treatment lead to the development of newly transmitted TB infections.
Our study shows that the MTB/RIF adoption could lead to an increasing of TB case-finding and a reduction in costs compared with standard and LF-LAM / MTB/RIF protocols.
Objectives
Retention of subjects in HIV treatment programmes is crucial for the success of treatment. We evaluated retention/loss to follow‐up (LTFU) in subjects receiving established care in Malawi.
...Methods
Data for HIV‐positive patients registered in Drug Resource Enhancement Against AIDS and Malnutrition centres in Malawi prior to 2014 were reviewed. Visits entailing HIV testing/counselling, laboratory evaluations, nutritional evaluation/supplementation, community support, peer education, and antiretroviral (ART) monitoring/pharmacy were noted. LTFU was defined as > 90 days without an encounter. Parameters potentially associated with LTFU were explored, with univariate/multivariate logistic regression analyses being performed.
Results
Fifteen thousand and ninety‐nine patients registered before 2014; 202 (1.3%) were lost to follow‐up (LTFU) (1.3%). Nine (0.5%) of 1744 paediatric patients were LTFU vs. 1.4% (n = 193) of 13 355 adults (P < 0.001). Subjects who were LTFU had fewer days in care than retained subjects (1338 vs. 1544, respectively; P < 0.001) and a longer duration of ART (1530 vs. 1300 days, respectively; P < 0.001). Subjects who were LTFU had higher baseline HIV viral loads (P = 0.016) and higher body mass indexes (P < 0.001), were more likely to live in urban settings (88% of patients who were LTFU lived in urban settings) with better housing relative risk (RR) 2.3; 95% confidence interval (CI) 1.67–3.09; P < 0.001, and were more likely to be educated (RR 1.88; 95% CI 1.42–2.50; P < 0.001). Distance to the centre and cost of transportation were associated with LTFU (RR 3.4; 95% CI 2.84–5.37; P < 0.001), as was absence of a maternal figure (RR 1.57; 95% CI 1.17–2.09; P < 0.001). Viral load, distance index, education and a maternal figure were predictive of LTFU.
Conclusions
Educated, urbanized HIV‐infected adults living far from programme centres are at high risk of LTFU, particularly if there is no maternal figure in the household. These variables must be taken into consideration when developing retention strategies.
Mathematical modelling is an important tool for understanding the dynamics of the spread of infectious diseases, which could be the result of a natural outbreak or of the intentional release of ...pathogenic biological agents. Decision makers and policymakers responsible for strategies to contain disease, prevent epidemics and fight possible bioterrorism attacks, need accurate computational tools, based on mathematical modelling, for preventing or even managing these complex situations. In this article, we tested the validity, and demonstrate the reliability, of an open-source software, the Spatio-Temporal Epidemiological Modeler (STEM), designed to help scientists and public health officials to evaluate and create models of emerging infectious diseases, analysing three real cases of Ebola haemorrhagic fever (EHF) outbreaks: Uganda (2000), Gabon (2001) and Guinea (2014). We discuss the cases analysed through the simulation results obtained with STEM in order to demonstrate the capability of this software in helping decision makers plan interventions in case of biological emergencies.
The use of dried blood spots (DBS) for HIV-1 viral load quantification can greatly improve access to viral monitoring for HIV-infected patients receiving treatment in resource-limited settings.
To ...evaluate and validate HIV viral load measurement from DBS in sub-Saharan Africa, with a reliable, all-automated, standard commercial assay such as the Abbott m2000.
A total of 277 DBS were collected in different health centres in Malawi and Mozambique and analysed for viral load determination using the Abbott m2000 assay with the corresponding plasma samples as gold standard. Samples were extracted using the m2000SP automatic extractor and then processed as the plasma samples using the specific 1.0 mL HIV-RNA DBS protocol.
Among samples with detectable HIV-RNA the correlation between viral load obtained from the paired 131 plasma and DBS samples was high (r=0.946). Overall, viral load values between DBS and plasma differed by less than 0.5 log unit in 90.1% of cases and by less than 1 log unit in 100% of cases. Using a threshold of 1 000 copies/mL (defining virological failure in resource-limited settings), sensitivity was 94.2% and specificity 98.6%, and both positive and negative predictive values were high (98.5% and 94.5%, respectively).
DBS extracted and processed using the Abbott automated system can be reliably used in resource-limited setting to diagnose virological failure.
Summary
The study included 309 HIV‐infected pregnant women receiving a lamivudine‐containing antiretroviral regimen from week 25 of gestational age until 6 months postpartum, during breastfeeding. ...Twenty‐seven of them (8.7%) were hepatitis B virus surface antigen (HBsAg) positive; at baseline, hepatitis B virus (HBV) DNA levels >3 log10 IU/mL (with a median level of 6.2 log10 IU/mL) were found in 10 women, who at one, three and six months postpartum had median levels of 5.2 log10 IU/mL, 4.5 log10 IU/mL and 2.8 log10 IU/mL, respectively. Twenty‐four of the 30 breast milk samples evaluated had undetectable HBV DNA and the other six had values between 15 and 155 IU/mL. Median lamivudine concentrations were 1070 ng/mL in serum and 684 ng/mL in breast milk. Among the 24 HBV‐exposed children with available samples, 16 always tested negative, four had a transient infection, one had an undetermined status and three (12.5%) first tested positive at Month 12 or Month 24. Among the children born to the HBV‐uninfected mothers of the same cohort, the rate of HBsAg positivity at 12–24 months was 2% (4/196). Our finding of the absence of significative levels of HBV DNA in the breast milk of co‐infected mothers supports the present recommendations for breastfeeding in HBV‐infected women. Horizontal transmission can be hypothesized for the infections detected in children at 12–24 months. Children born to HBV‐positive mothers remained at higher risk of postnatal HBV acquisition compared to those born to HBV‐negative women.
The aim of this paper is to describe the protocol of a study assessing the impact of a Community-based pro-Active Monitoring Program, by measuring the effect in counteracting the adverse outcomes ...related to frailty.
a prospective pragmatic trial will be carried out to describe the impact of an intervention on people aged>80, adjusted for relevant parameters: demographic variables, comorbidities, disability and bio-psycho-social frailty. They have been assessed with the Functional Geriatric Evaluation questionnaire that is a validated tool. Mortality, Acute Hospital Admission rates, Emergency Room Visit rates and Institutionalization rates are the main outcomes to be evaluated annually, over three years. Two groups of patients, made up by 578 cases (undergoing the intervention under study) and 607 controls have been enrolled and interviewed.
at baseline the two groups are quite similar for age, living arrangement, comorbidity, disability and cognitive status. They differ in education, economic resources and physical status (that are better in the control group) and in social resources (that is better in the case group). The latter was expected since the intervention is focused on increasing social capital at individual and community level and aimed at improving survival among the cases as well as reducing the recourse to hospital and residential Long Term Care.
The proposed study addresses a crucial issue: assessing the impact of a
service consisting of social and health interventions aimed at reducing social isolation and improving access to health care services.
CFD (Computational Fluid Dynamics) simulations are widely used nowadays to predict the behaviour of fluids in pure research and in industrial applications. This approach makes it possible to get ...quantitatively meaningful results, often in good agreement with the experimental ones. The aim of this paper is to show how CFD calculations can help to understand the time evolution of two possible CBRNe (Chemical-Biological-Radiological-Nuclear-explosive) events: (1) hazardous dust mobilization due to the interaction between a jet of air and a metallic powder in case of a LOVA (Loss Of Vacuum Accidents) that is one of the possible accidents that can occur in experimental nuclear fusion plants; (2) toxic gas release in atmosphere. The scenario analysed in the paper has consequences similar to those expected in case of a release of dangerous substances (chemical or radioactive) in enclosed or open environment during nonconventional events (like accidents or man-made or natural disasters).
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