Statistical and econometric analysis of the treatment of HIV/AIDS

The epidemic of HIV/AIDS in the United States is constantly changing and evolving, starting from patient zero to now an estimated 650,000 to 900,000 Americans infected. The nature and course of HIV changed dramatically with the introduction of antiretrovirals. This discourse examines many different facets of HIV from the beginning where there wasn't any treatment for HIV until the present era of highly active antiretroviral therapy (HAART). By utilizing statistical analysis of clinical data, this paper examines where we were, where we are and projections as to where treatment of HIV/AIDS is headed.

Chapter Two describes the datasets that were used for the analyses. The primary database utilized was collected by myself from an outpatient HIV clinic. The data included dates from 1984 until the present. The second database was from the Multicenter AIDS Cohort Study (MACS) public dataset. The data from the MACS cover the time between 1984 and October 1992. Comparisons are made between both datasets.

Chapter Three discusses where we were. Before the first anti-HIV drugs (called antiretrovirals) were approved, there was no treatment to slow the progression of HIV. The first generation of antiretrovirals, reverse transcriptase inhibitors such as AZT (zidovudine), DDI (didanosine), DDC (zalcitabine), and D4T (stavudine) provided the first treatment for HIV. The first clinical trials showed that these antiretrovirals had a significant impact on increasing patient survival. The trials also showed that patients on these drugs had increased CD4+ T cell counts. Chapter Three examines the distributions of CD4 T cell counts. The results show that the estimated distributions of CD4 T cell counts are distinctly non-Gaussian. Thus distributional assumptions regarding CD4 T cell counts must be taken, into account when performing analyses with this marker. The results also show the estimated CD4 T cell distributions for each disease stage: asymptomatic, symptomatic and AIDS are non-Gaussian. Interestingly, the distribution of CD4 T cell counts for the asymptomatic period is significantly below that of the CD4 T cell distribution for the uninfected population suggesting that even in patients with no outward symptoms of HIV infection, there exists high levels of immunosuppression.

Chapter Four discusses where we are at present. HIV quickly grew resistant to reverse transcriptase inhibitors which were given sequentially as mono or dual therapy. As resistance grew, the positive effects of the reverse transcriptase inhibitors on CD4 T cell counts and survival dissipated. As the old era faded a new era characterized by a new class of drugs and new technology changed the way that we treat HIV-infected patients. Viral load assays were able to quantify the levels of HIV RNA in the blood. By quantifying the viral load, one now had a faster, more direct way to test antiretroviral regimen efficacy. Protease inhibitors, which attacked a different region of HIV than reverse transcriptase inhibitors, when used in combination with other antiretroviral agents were found to dramatically and significantly reduce the HIV RNA levels in the blood. Patients also experienced significant increases in CD4 T cell counts. For the first time in the epidemic, there was hope. It was hypothesized that with HAART, viral levels could be kept so low that the immune system as measured by CD4 T cell counts would be able to recover. If these viral levels could be kept low enough, it would be possible for the immune system to eradicate the virus. The hypothesis of immune reconstitution, that is bringing CD4 T cell counts up to levels seen in uninfected patients, is tested in Chapter Four. It was found that for these patients, there was not enough of a CD4 T cell increase to be consistent with the hypothesis of immune reconstitution.

In Chapter Five, the effectiveness of long-term HAART is analyzed. Survival analysis was conducted on 213 patients on long-term HAART. The primary endpoint was presence of an AIDS defining illness. A high level of clinical failure, or progression to an endpoint, was found.

Chapter Six yields insights into where we are going. New technology such as viral genotypic testing, that looks at the genetic structure of HIV and determines where mutations have occurred, has shown that HIV is capable of producing resistance mutations that confer multiple drug resistance. This section looks at resistance issues and speculates, ceterus parabis, where the state of HIV is going. This section first addresses viral genotype and the correlates of viral load and disease progression. A second analysis looks at patients who have failed their primary attempts at HAART and subsequent salvage therapy. It was found that salvage regimens, efforts to control viral replication through the administration of different combinations of antiretrovirals, were not effective in 90 percent of the population in controlling viral replication. Thus, primary attempts at therapy offer the best change of viral suppression and delay of disease progression. Documentation of transmission of drug-resistant virus suggests that the public health crisis of HIV is far from over. Drug resistant HIV can sustain the epidemic and hamper our efforts to treat HIV infection. The data presented suggest that the decrease in the morbidity and mortality due to HIV/AIDS is transient. Deaths due to HIV will increase and public health officials must prepare for this eventuality unless new treatments become available. These results also underscore the importance of the vaccine effort.

The final chapter looks at the economic issues related to HIV. The direct and indirect costs of treating HIV/AIDS are very high. For the first time in the epidemic, there exists treatment that can actually slow disease progression. The direct costs for HAART are estimated. It is estimated that the direct lifetime costs for treating each HIV infected patient with HAART is between $353,000 to $598,000 depending on how long HAART prolongs life. If one looks at the incremental cost per year of life saved it is only $101,000. This is comparable with the incremental costs per year of life saved from coronary artery bypass surgery.

Policy makers need to be aware that although HAART can delay disease progression, it is not a cure and HIV is not over. The results presented here suggest that the decreases in the morbidity and mortality due to HIV are transient. Policymakers need to be prepared for the eventual increase in AIDS incidence and mortality. Costs associated with HIV/AIDS are also projected to increase. The cost savings seen recently have been from the dramatic decreases in the incidence of AIDS defining opportunistic infections. As patients who have been on HAART the longest start to progress to AIDS, policymakers and insurance companies will find that the cost of treating HIV/AIDS will increase.

On the Role of Delays in Biological Systems : Analysis and Design

This work quantifies the nature of delays in genetic regulatory networks and their effect on system dynamics. It is known that a time lag can emerge from a sequence of biochemical reactions. Applying this modeling framework to the protein production processes, delay distributions are derived in a stochastic (probability density function) and deterministic setting (impulse function), whilst being shown to be equivalent under different assumptions. The dependence of the distribution properties on rate constants, gene length, and time-varying temperatures is investigated. Overall, the distribution of the delay in the context of protein production processes is shown to be highly dependent on the size of the genes and mRNA strands as well as the reaction rates. Results suggest longer genes have delay distributions with a smaller relative variance, and hence, less uncertainty in the completion times, however, they lead to larger delays. On the other hand large uncertainties may actually play a positive role, as broader distributions can lead to larger stability regions when this formalization of the protein production delays is incorporated into a feedback system.

Furthermore, evidence suggests that delays may play a role as an explicit design into existing controlling mechanisms. Accordingly, the reccurring dual-feedback motif is also investigated with delays incorporated into the feedback channels. The dual-delayed feedback is shown to have stabilizing effects through a control theoretic approach. Lastly, a distributed delay based controller design method is proposed as a potential design tool. In a preliminary study, the dual-delayed feedback system re-emerges as an effective controller design.

Classical correlated imaging from the perspective of coherent-mode representation

We use coherent-mode representation of partially coherent fields to analyze correlated imaging with classical light sources. This formalism is very useful to study the imaging quality. By decomposing the unknown object as the superposition of different coherent modes, the components corresponding to small eigenvalues cannot be well imaged. The generated images depend crucially on the distribution of the eigenvalues of the coherent-mode representation of the source and the decomposition coefficients of the objects. Three kinds of correlated imaging schemes are analyzed numerically.

The state of the benthos in the Rybinsk reservoir, 1953-55. [Translation of the abstract from: Trudy biol. Sta. Borok 3, 195-213, 1958]

This abstract summarises the 1953-1955 surveys of the distribution of benthos in the Rybinsk Reservoirs. It includes the mean biomass of benthos.

The effect of the rotating double-prism wide-angle laser beam scanner on the beam shape

In this paper, we describe a wide-angle laser beam scanner and the rigorous result of the wide-angle laser beam scanner was obtained with the help of the vector refraction theory. Using the rigorous results, the distortion of the beam shape was discussed. The distortion of the beam shape is varying with the different relative angles of the double prisms. According to the conservation of the energy, the distribution of the laser intensity is changed too. (c) 2005 Elsevier GmbH. All rights reserved.

A Multiwavelength Study of the Intracluster Medium and the Characterization of the Multiwavelength Sub/millimeter Inductance Camera

The first part of this thesis combines Bolocam observations of the thermal Sunyaev-Zel’dovich (SZ) effect at 140 GHz with X-ray observations from Chandra, strong lensing data from the Hubble Space Telescope (HST), and weak lensing data from HST and Subaru to constrain parametric models for the distribution of dark and baryonic matter in a sample of six massive, dynamically relaxed galaxy clusters. For five of the six clusters, the full multiwavelength dataset is well described by a relatively simple model that assumes spherical symmetry, hydrostatic equilibrium, and entirely thermal pressure support. The multiwavelength analysis yields considerably better constraints on the total mass and concentration compared to analysis of any one dataset individually. The subsample of five galaxy clusters is used to place an upper limit on the fraction of pressure support in the intracluster medium (ICM) due to nonthermal processes, such as turbulent and bulk flow of the gas. We constrain the nonthermal pressure fraction at r500c to be less than 0.11 at 95% confidence, where r500c refers to radius at which the average enclosed density is 500 times the critical density of the Universe. This is in tension with state-of-the-art hydrodynamical simulations, which predict a nonthermal pressure fraction of approximately 0.25 at r500c for the clusters in this sample.

The second part of this thesis focuses on the characterization of the Multiwavelength Sub/millimeter Inductance Camera (MUSIC), a photometric imaging camera that was commissioned at the Caltech Submillimeter Observatory (CSO) in 2012. MUSIC is designed to have a 14 arcminute, diffraction-limited field of view populated with 576 spatial pixels that are simultaneously sensitive to four bands at 150, 220, 290, and 350 GHz. It is well-suited for studies of dusty star forming galaxies, galaxy clusters via the SZ Effect, and galactic star formation. MUSIC employs a number of novel detector technologies: broadband phased-arrays of slot dipole antennas for beam formation, on-chip lumped element filters for band definition, and Microwave Kinetic Inductance Detectors (MKIDs) for transduction of incoming light to electric signal. MKIDs are superconducting micro-resonators coupled to a feedline. Incoming light breaks apart Cooper pairs in the superconductor, causing a change in the quality factor and frequency of the resonator. This is read out as amplitude and phase modulation of a microwave probe signal centered on the resonant frequency. By tuning each resonator to a slightly different frequency and sending out a superposition of probe signals, hundreds of detectors can be read out on a single feedline. This natural capability for large scale, frequency domain multiplexing combined with relatively simple fabrication makes MKIDs a promising low temperature detector for future kilopixel sub/millimeter instruments. There is also considerable interest in using MKIDs for optical through near-infrared spectrophotometry due to their fast microsecond response time and modest energy resolution. In order to optimize the MKID design to obtain suitable performance for any particular application, it is critical to have a well-understood physical model for the detectors and the sources of noise to which they are susceptible. MUSIC has collected many hours of on-sky data with over 1000 MKIDs. This work studies the performance of the detectors in the context of one such physical model. Chapter 2 describes the theoretical model for the responsivity and noise of MKIDs. Chapter 3 outlines the set of measurements used to calibrate this model for the MUSIC detectors. Chapter 4 presents the resulting estimates of the spectral response, optical efficiency, and on-sky loading. The measured detector response to Uranus is compared to the calibrated model prediction in order to determine how well the model describes the propagation of signal through the full instrument. Chapter 5 examines the noise present in the detector timestreams during recent science observations. Noise due to fluctuations in atmospheric emission dominate at long timescales (less than 0.5 Hz). Fluctuations in the amplitude and phase of the microwave probe signal due to the readout electronics contribute significant 1/f and drift-type noise at shorter timescales. The atmospheric noise is removed by creating a template for the fluctuations in atmospheric emission from weighted averages of the detector timestreams. The electronics noise is removed by using probe signals centered off-resonance to construct templates for the amplitude and phase fluctuations. The algorithms that perform the atmospheric and electronic noise removal are described. After removal, we find good agreement between the observed residual noise and our expectation for intrinsic detector noise over a significant fraction of the signal bandwidth.

Applications of a nuclear technique for depth-sensitive hydrogen analysis : trapped H in lunar samples and the hydration of terrestrial obsidian

The resonant nuclear reaction ¹⁹F(p,αy)¹⁶O has been used to perform depth-sensitive analyses for both fluorine and hydrogen in solid samples. The resonance at 0.83 MeV (center-of-mass) in this reaction has been applied to the measurement of the distribution of trapped solar protons in lunar samples to depths of ~1/2µm. These results are interpreted in terms of a redistribution of the implanted H which has been influenced by heavy radiation damage in the surface region. Fluorine determinations have been performed in a 1-µm surface layer on lunar and meteoritic samples using the same ¹⁹F(p,αy)¹⁶O resonance. The measurement of H depth distributions has also been used to study the hydration of terrestrial obsidian, a phenomenon of considerable archaeological interest as a means of dating obsidian artifacts. Additional applications of this type of technique are also discussed.

The ecology of the Gussage, a lined winterbourne

The Gussage, a Dorset winterhourne (intermittent chalk stream), has been used to convey water from a compensation borehole to the River Allen to supplement its flow to meet demand for water. Sections of the Gussage have been lined with chalk, butyl sheeting or polythene sheeting to prevent water loss through the porous bed. The effects of this major environmental modification associated with these abstraction practices in the winterbourne catchments have been studied in the Gussage system since 1973. To compensate for the lack of adequate pre-lining data, comparative studies have been made on 3 small unlined chalk streams of varying flow regimes, ie. the Crichel (a winterbourne), the North Winterbourne and the Tarrant (permanent discharge in the reaches studies). The distribution of macrophytes and invertebrates in winterbournes are compared with that in natural and artificial permanent streams. Statistical analysis showed samples from the winterbourne sites and the unmodified permanent stream sites are quite distinct, despite the fact that no samples were taken from winterbourne sites during the dry phase. This emphasizes the differences between the fauna of an intermittent and a permanent stream and suggests that alteration of the flow regime could be a significant factor. Where flow regime has been altered, as in the Gussage downstream of the borehole, the samples occupy an intermediate position. Within this group of modified sites there is no apparent gross difference between the invertebrates of lined or unlined reaches.

The pyrolysis of n-butane

A study of the pyrolysis of n-butane was carried out using an all-gold tubular reactor. The initial rate of decomposition of the n-butane was of 1.50-order with respect to the partial pressure of the n-butane. A free radical mechanism, similar to that originally proposed by Rice, accounted satisfactorily for the distribution of products. Oxygen was rigorously excluded from the pyrolysis gases. The surfaces of the gold reactor had been acid-treated to remove oxide impurities. Some preliminary experiments were performed in the partial oxidation of n-butane.

Age- and length-at-maturity of female arrowtooth flounder (Atheresthes stomias) in the Gulf of Alaska

Arrowtooth flounder (Atheresthes stomias) has had the highest abundance of any groundfish species in the Gulf of Alaska since the 1970s (Matarese et al., 2003; Turnock et al., 2005; Blood et al., 2007); however, commercial catches have been restricted because Pacific halibut (Hippoglossus stenolepis) are caught as bycatch in the fishery. Arrowtooth flounder plays a key role in the ecosystem because it is a dominant organism within the food web, both as an apex predator of fish and invertebrates, as well as an important prey for walleye pollock (Theragra chalcogramma; Aydin et al., 2002). Walleye pollock is the dominant groundfish in the Bering Sea, a principal groundfish in the Gulf of Alaska, and the primary prey for marine mammals. The distribution of arrowtooth flounder extends from Cape Navarin and the eastern Sea of Okhotsk in Russia, across the Bering Sea, Aleutian Islands, Gulf of Alaska, and south to the coast of central California (Shuntov, 1964; Britt and Martin, 2001; Chetvergov, 2001; Weinberg et al., 2002; Zenger, 2004). Because of the importance of arrowtooth flounder in the marine ecosystem of A laska, a maturity study of this species was undertaken to determine age-at-maturity, which is essential for age-based stock management models. Before these results, management has had to rely upon a length-at-maturity-based estimate (Zimmermann, 1997) to manage stocks in the Gulf of Alaska (GOA), Bering Sea, and Aleutian Islands. The central GOA was selected as the location for this maturity study Age- and length-at-maturity of female arrowtooth flounder (Atheresthes stomias) in the Gulf of Alaska because it contains approximately 70% of the total Gulf of Alaska arrowtooth flounder biomass (1.9×106 t, age 3 and older)— the highest percentage in the world (Shuntov, 1964; Britt and Martin, 2001; Weinberg et al., 2002; Wilderbuer and Nichol, 2006).

Studies on the occurrence of coliforms and streptococci in coastal waters of Bombay

The distribution of coliforms and streptococci in Bombay coastal waters was investigated in order to determine the state of pollution in the area. Findings show the incidence of pollution to be of a recurring nature, primarily due to discharge of raw or improperly treated sewage; thus regular monitoring of the incidence of coliforms and streptococci is of importance in determining the public health safety of the beaches and coastal waters.

Results of the Austrian-Ceylonese hydrobiological mission 1970 of the 1st Zoological Institute of the University of Vienna (Austria) and the Department of Zoology of the Vidyalankara University of Ceylon, Kelaniya. Pt. 5. Decapoda Caridea

The first comprehensive study on the freshwater Caridea of Sri Lanka was by Arudpragrasm and Costa in 1961. Although it was the intention of these authors to continue this study no opportunity was available to them. The present faunal survey however has afforded the present writer to make a detailed study of the distribution of these shrimps especially in the mountain streams of the south-west of Sri Lanka. Two species and two sub-species of Caridina, one species of Atya and four species of Macrobrachium were collected by the hydrobiological mission from the hill streams of Sri Lanka.

Distribution of mercury in a tropical estuary (India) situated near a chloro-alkali plant

The distribution of mercury in water, sediment and some biological samples of the Rushikulya estuary, east coast of India were assessed during Jan-Dec. 1989. Both the dissolved plus acid leachable mercury contents in water and the sediment mercury discerned conspicuous spatial and seasonal fluctuations. Adsorption on to the suspended particulates was found to be the most likely mechanism for removal of mercury from the water column. Exchange of mercury from sediments to water was observed at high salinities (20-30x10-3). The residual mercury contents in the biological samples revealed that bio-accumulation by bottom-dwelling organisms are higher than the pelagic components.

Distribution of vitamin B-12 in some fishes and marine invertebrates

Distribution of vitamin B-12 in the skeletal muscle of several marine and fresh water fish and marine invertebrates are reported. The vitamin B-12 content of white muscle of various fish ranges between 0.05 and 1.5 micrograms. The elasmobranch fish, such as sharks and rays, has a lower levels of vitamin B-12. The distribution of vitamin B-12 in the red muscle, heart, brain and liver of various fish is also shown. Content in red muscle varies between 3 and 22 micrograms, averaging 8 micrograms. The values show that the heart is a rich source of vitamin B-12. Internal organs are also rich in vitamin B

Cholesterol content in the eggs of some freshwater teleosts

The authors report the distribution of cholesterol in the ripe, unspawned eggs of 10 spp of teleost (carps, catfish and murrels) together with values for egg diam. The egg, with its relatively abundant yolk, is shown to be fairly rich in cholesterol, though values differ from sp to sp. The lowest value (700 mg/100 g) was recorded from Wallago attu, and the highest (1537 mg/100g) from Heteropneustes fossilis. In general the levels are lowest in carp eggs. No definite relationship could be established between lipid and cholesterol contents, or between egg diam and total cholesterol. The role of cholesterol in physiology of fish is discussed; it is noted that the carnivorous fish tended to have higher levels of cholesterol in their eggs.