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DOE OSTI2019

Estimation of cerebral blood flow velocity during breath-hold challenge using artificial neural networks

The effect of untreated Obstructive Sleep Apnoea (OSA) on cerebral haemodynamics and CA impairment is an active field of research interest. A breath-hold challenge is usually used in clinical and research settings to simulate cardiovascular and cerebrovascular changes that mimic OSA events. This work utilises temporal arterial oxygen saturation (SpO 2 ) and photoplethysmography (PPG) signals to estimate the temporal cerebral blood flow velocity (CBFv) waveform. Measurements of CBFv, SpO 2 , and PPG, were acquired concurrently from volunteers performing two different protocols of breath-hold challenge in the supine position. Past values of the SpO 2 and PPG signals were used to estimate the current values of CBFv using different permutations and topologies of supervised learning with shallow artificial neural networks (ANNs). Measurements from one protocol were used to train the ANNs and find the optimum topologies, which in turn were tested using the other protocol. Data collected from 10 normotensive, healthy subjects (four females, age 28.5 ± 6.1 years, Body Mass Index (BMI) 24.0 ± 4.7 kg/m 2 ) were used in this study. The results show that different subjects have different optimum topologies for ANNs, thus indicating the effects of inter-subject variability on ANNs. Successfully reconstructed blind waveforms for the same subject group in the second protocol showed a reasonable accuracy of 60–80% estimation compared to the measured waveforms.

59 BASIC BIOLOGICAL SCIENCES↗

DOE OSTI2018

Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis

Abstract BACKGROUND The influence of age on balance of benefit vs. potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS Our study included 18 RCTs (n = 53,993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction = 0.02). Compared to treatment with final achieved SBP 140–150 mm Hg, a lower achieved SBP (<140 mm Hg) was significantly associated with decreased risk of stroke (relative risk = 0.68; 95% confidence interval = 0.55–0.85), HF (0.77; 0.60–0.99), cardiovascular death (0.68; 0.52–0.89), and MACE (0.83; 0.69–0.99). CONCLUSIONS To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension.

Huang, Chi-Jung↗

NASA NTRS2020

The SUrvey for Pulsars and Extragalactic Radio Bursts - IV. Discovery and polarimetry of a 12.1-s radio pulsar

We report the discovery of PSR J2251−3711, a radio pulsar with a spin period of 12.1 s, the second longest currently known. Its timing parameters imply a characteristic age of 15 Myr, a surface magnetic field of 1.3 × 10^(13) G, and a spin-down luminosity of 2.9 × 10^(29) erg/s. Its dispersion measure of 12.12(1) pc/cu. cm leads to distance estimates of 0.5 and 1.3 kpc according to the NE2001 and YMW16 Galactic free electron density models, respectively. Some of its single pulses show an uninterrupted 180-deg sweep of the phase-resolved polarization position angle, with an S-shape reminiscent of the rotating vector model prediction. However, the fact that this sweep occurs at different phases from one pulse to another is remarkable and without straightforward explanation. Although PSR J2251−3711 lies in the region of the P − P˙ parameter space occupied by the X-ray isolated neutron stars (XINS), there is no evidence for an X-ray counterpart in our Swift XRT observation; this places a 99 per cent-confidence upper bound on its unabsorbed bolometric thermal luminosity of 1.1 × 10^(31) (d/1 kpc)^2 erg/s for an assumed temperature of 85 eV, where d is the distance to the pulsar. Further observations are needed to determine whether it is a rotation-powered pulsar with a true age of at least several Myr, or a much younger object such as an XINS or a recently cooled magnetar. Extreme specimens like PSR J2251−3711 help bridge populations in the so-called neutron star zoo in an attempt to understand their origins and evolution.

V Morello↗

DOE OSTI2015

Observations of 14 CO 2 in ecosystem respiration from a temperate deciduous forest in Northern Wisconsin

We show that the 14 CO 2 composition of plant and soil respiration can be used to determine the residence time of photosynthetically fixed carbon before it is released back to the atmosphere. To estimate the residence time of actively cycled carbon in a temperate forest, we employed two approaches for estimating the Δ 14 CO 2 of ecosystem respiration (Δ 14 C-R eco ) at the Willow Creek AmeriFlux site in Northern Wisconsin, USA. Our first approach was to construct nighttime Keeling plots from subcanopy profiles of Δ 14 CO 2 and CO 2 , providing estimates of Δ 14 C-R eco of 121.7‰ in June and 42.0‰ in August 2012. These measurements are likely dominated by soil fluxes due to proximity to the ground level. Our second approach utilized samples taken over 20 months within the forest canopy and from 396 m above ground level at the nearby LEF NOAA tall tower site (Park Falls, WI). In this canopy-minus-background approach we employed a mixing model described by Miller and Tans (2003) for estimating isotopic sources by subtracting time-varying background conditions. For the period from May 2011 to December 2012 the estimated Δ 14 C-R eco using the Miller-Tans model was 76.8‰. Together, these Δ 14 C-R eco values represent mean R eco carbon ages of approximately 1–19 years. We also found that heterotrophic soil-respired Δ 14 C at Willow Creek was 5–38‰ higher (i.e., 1–10 years older) than predicted by the Carnegie-Ames-Stanford Approach global biosphere carbon model for the 1 × 1 pixel nearest to the site. Finally, this study provides much needed observational constraints of ecosystem carbon residence times, which are a major source of uncertainty in terrestrial carbon cycle models.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2013

EVOLUTION OF THE WATER MASER EXPANDING SHELL IN W75N VLA 2

We present Very Long Baseline Interferometry (VLBI) observations of 22 GHz H{sub 2}O masers in the high-mass star-forming region of W75N, carried out with VLBI Exploration of Radio Astrometry (VERA) for three epochs in 2007 with an angular resolution of {approx}1 mas. We detected H{sub 2}O maser emission toward the radio jet in VLA 1 and the expanding shell-like structure in VLA 2. The spatial distribution of the H{sub 2}O masers detected with VERA and measured proper motions around VLA 1 and VLA 2 are similar to those found with previous VLBI observations in epochs 1999 and 2005, with the masers in VLA 1 mainly distributed along a linear structure parallel to the radio jet and, on the other hand, forming a shell-like structure around VLA 2. We have made elliptical fits to the VLA 2 H{sub 2}O maser shell-like structure observed in the different epochs (1999, 2005, and 2007), and found that the shell is still expanding eight years after its discovery. From the difference in the size of the semi-major axes of the fitted ellipses in epochs 1999 ({approx_equal}71 {+-} 1 mas), 2005 ({approx_equal}97 {+-} 3 mas), and 2007 ({approx_equal}111 {+-} 1 mas), we estimate an average expanding velocity of {approx}5 mas yr{sup -1}, similar to the proper motions measured in the individual H{sub 2}O maser features. A kinematic age of {approx}20 yr is derived for this structure. In addition, our VERA observations indicate an increase in the ellipticity of the expanding shell around VLA 2 from epochs 1999 to 2007. In fact, the elliptical fit of the VERA data shows a ratio of the minor and major axes of {approx}0.6, in contrast with an almost circular shape for the shell detected in 1999 and 2005 (b/a {approx} 0.9). This suggests that we are probably observing the formation of a jet-driven H{sub 2}O maser structure in VLA2, evolving from a non-collimated pulsed-outflow event during the first stages of evolution of a massive young stellar object (YSO). This may support predictions made earlier by other authors on this issue, consistent with recent magnetohydrodynamical simulations. We discuss possible implications of our results in the study of the first stages of evolution of massive YSOs.

79 ASTRONOMY AND ASTROPHYSICS↗

DOE OSTI2023

2023 Status Report - Fiberboard Properties and Degradation Rates for Storage of 9975 Shipping Package in KAC

Thermal, mechanical, and physical properties have been measured on fiberboard samples aging for up to 18 years at accelerated conditions. The aging environments include elevated temperature up to 250 ºF (the maximum allowed service temperature for fiberboard in 9975 packages) and elevated humidity. Accelerated aging results have been analyzed and used to build aging models. Correlations relating several properties (thermal conductivity, energy absorption, weight, dimensions, and density) to their rate of change in potential storage environments have been developed. Combined with an estimate of the actual conditions the fiberboard experiences in K-Area Complex (KAC), these models allow development of service life predictions.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

DOE OSTI2024

2024 Status Report - Fiberboard Properties and Degradation Rates for Storage of 9975 Shipping Package in KAC

Fiberboard assemblies in the 9975 package were identified as susceptible to aging and degradation under long-term storage conditions. Thermal, mechanical, and physical properties have been measured on fiberboard samples aging for up to 19 years at accelerated conditions. The aging environments include elevated temperature up to 250 ºF (the maximum allowed service temperature for fiberboard in 9975 packages) and elevated humidity. Accelerated aging results have been analyzed and used to build aging models. Correlations relating several properties (thermal conductivity, energy absorption, weight, dimensions, and density) to their rate of change in potential storage environments have been developed. Combined with an estimate of the actual conditions the fiberboard experiences in K-Area Complex (KAC), these models allow development of service life predictions.

36 MATERIALS SCIENCE↗

DOE OSTI2025

Employing Eye Trackers to Reduce Nuisance Alarms

When process operators anticipate an alarm prior to its annunciation, that alarm loses information value and becomes a nuisance. This study investigated using eye trackers to measure and adjust the salience of alarms with three methods of gaze-based acknowledgement (GBA) of alarms that estimate operator anticipation. When these methods detected possible alarm anticipation, the alarm’s audio and visual salience was reduced. A total of 24 engineering students (male = 14, female = 10) aged between 18 and 45 were recruited to predict alarms and control a process parameter in three scenario types (parameter near threshold, trending, or fluctuating). The study evaluated whether behaviors of the monitored parameter affected how frequently the three GBA methods were utilized and whether reducing alarm salience improved control task performance. The results did not show significant task improvement with any GBA methods (F(3,69) = 1.357, p = 0.263, partial η 2 = 0.056). However, the scenario type affected which GBA method was more utilized (X 2 (2, N = 432) = 30.147, p < 0.001). Alarm prediction hits with gaze-based acknowledgements coincided more frequently than alarm prediction hits without gaze-based acknowledgements (X 2 (1, N = 432) = 23.802, p < 0.001, OR = 3.877, 95% CI 2.25–6.68, p < 0.05). Participant ratings indicated an overall preference for the three GBA methods over a standard alarm design (F(3,63) = 3.745, p = 0.015, partial η 2 = 0.151). This study provides empirical evidence for the potential of eye tracking in alarm management but highlights the need for additional research to increase validity for inferring alarm anticipation.

99 - GENERAL AND MISCELLANEOUS↗

NASA NTRS1974

Duration of magnetic field(s) acting on meteorite parent body(s)

An overview is presented on the efforts being made to estimate the time that the magnetic field(s) existed and acted on meteorite parent bodies. The basic premise is that if a sample exhibits a low K-Ar age, it is the requisite amount of Ar-40. This assumption is applied to a preliminary analysis of the Farmington chondrite.

Rowe, M. W.↗

NASA NTRS1992

Rates of collapse and evaporation of globular clusters

Observational estimates of the dynamical relaxation times of Galactic globular clusters are used here to estimate the present rate at which core collapse and evaporation are occurring in them. A core collapse rate of 2 +/- 1 per Gyr is found, which for a Galactic age of about 12 Gyr agrees well with the fact that 27 clusters have surface brightness profiles with the morphology expected for the postcollapse phase. A destruction and evaporation rate of 5 +/- 3 per Gyr is found, suggesting that a significant fraction of the Galaxy's original complement of globular clusters have perished through the combined effects of mechanisms such as relaxation-driven evaporation and shocking due to interaction with the Galactic disk and bulge.

Hut, Piet↗

NASA NTRS2003

Obscured Star-Formation in Merging Galaxies: High Resolution Radio Imaging of a Time-Ordered Sequence

We present new, deep, high resolution 6cm and 4cm radio continuum images of the central regions of a time-ordered sequence of seven large galaxy mergers. The radio observations are able to detect star-forming re- gions that are completely obscured at optical wavelengths. In all systems, we detect numerous compact radio sources embedded in more diffuse ra- dio emission, with limiting luminosities of approx. 1-5 x 10(exp l8) W Hz or approx. 1-5 times the luminosity of Cas A. Many of the compact radio sources are loosely associated with active starforming regions but not with specific optical or W emission sources. Several of the compact radio sources are coincident with Ultra-luminous X-ray objects (ULX's). In most systems, we are able to measure reliable spectral indices for the stronger sources. We find that the fraction of compact radio cources with nominally flat radio spectral indices (indicating they ae dominated by thermal radio emission from HII regions) decreases with merger age, while the fraction of sources with nonimally steep spectral indices (indicating they are dominated by nonthermal emission from supernova remnants) increases. For the flat-spectrum sources, we estimate the numbers of young massive stars, associated ionized gas masses, we estimate supernova rates and required star-formation rates, We compare these results with those from other well-studied merging galaxy systems and from other determinations of star-formation rates. We gratefully acknowledge use of the NRAO Very Large Array (VLA) and the VLA Archive. NRAO is a facility of the National Science Foundation, operated under cooperative agreement by Associated Universities, Inc.

Neff, S. G.↗

NASA NTRS2013

A Combined Very Large Telescope and Gemini Study of the Atmosphere of the Directly Imaged Planet, Beta Pictoris b

We analyze new/archival VLT/NaCo and Gemini/NICI high-contrast imaging of the young, self-luminous planet Beta Pictoris b in seven near-to-mid IR photometric filters, using advanced image processing methods to achieve high signal-to-noise, high precision measurements. While Beta Pic b's near-IR colors mimic those of a standard, cloudy early-to-mid L dwarf, it is overluminous in the mid-infrared compared to the field L/T dwarf sequence. Few substellar/planet-mass objects-i.e., κ And b and 1RXJ 1609B-match Beta Pic b's JHKsL photometry and its 3.1 micron and 5 micron photometry are particularly difficult to reproduce. Atmosphere models adopting cloud prescriptions and large (approx. 60 micron)dust grains fail to reproduce the Beta Pic b spectrum. However, models incorporating thick clouds similar to those found forHR8799 bcde, but also with small (a fewmicrons) modal particle sizes, yield fits consistent with the data within the uncertainties. Assuming solar abundance models, thick clouds, and small dust particles (a = 4 micron), we derive atmosphere parameters of log(g) = 3.8 +/- 0.2 and Teff = 1575-1650 K, an inferred mass of 7+4 −3 MJ, and a luminosity of log(L/L) approx. −3.80 +/- 0.02. The best-estimated planet radius, is approx. equal to 1.65 +/- 0.06 RJ, is near the upper end of allowable planet radii for hot-start models given the host star's age and likely reflects challenges constructing accurate atmospheric models. Alternatively, these radii are comfortably consistent with hot-start model predictions if Beta Pic b is younger than is approx. equal to 7 Myr, consistent with a late formation well after its host star's birth approx. 12+8 −4 Myr ago.

overluminous↗

NASA NTRS2019

Role of forest regrowth in global carbon sink dynamics

Although the existence of a large carbon sink in terrestrial ecosystems is well-established, the drivers of this sink remain uncertain. It has been suggested that perturbations to forest demography caused by past land-use change, management, and natural disturbances may be causing a large component of current carbon uptake. Here we use a global compilation of forest age observations, combined with a terrestrial biosphere model with explicit modeling of forest regrowth, to partition the global forest carbon sink between old-growth and regrowth stands over the period 1981–2010. For 2001–2010 we find a carbon sink of 0.85 (0.66–0.96) Pg/year located in intact old-growth forest, primarily in the moist tropics and boreal Siberia, and 1.30 (1.03–1.96) Pg/year located in stands regrowing after past disturbance. Approaching half of the sink in regrowth stands would have occurred from demographic changes alone, in the absence of other environmental changes. These age-constrained results show consistency with those simulated using an ensemble of demographically-enabled terrestrial biosphere models following an independent reconstruction of historical land use and management. We estimate that forests will accumulate an additional 69 (44–131) Pg C in live biomass from changes in demography alone if natural disturbances, wood harvest, and reforestation continue at rates comparable to those during 1981–2010. Our results confirm that it is not possible to understand the current global terrestrial carbon sink without accounting for the sizeable sink due to forest demography. They also imply that a large portion of the current terrestrial carbon sink is strictly transient in nature.

forest↗

NASA NTRS2022

Present-Day and Future PM 2.5 and O 3 -Related Global and Regional Premature Mortality in the EVAv6.0 Health Impact Assessment Model

We used the EVAv6.0 system to estimate the present (2015) and future (2015–2050) global PM 2.5 and O 3 -related premature mortalities, using simulated surface concentrations from the GISS-E2.1-G Earth system model. The PM 2.5 -related global premature mortality is estimated to be 4.3 and 4.4 million by the non-linear and linear models, respectively. Ischemic heart diseases are found to be the leading cause of PM 2.5 -related premature deaths, contributing by 35% globally. Both long-term and short-term O 3 -related premature deaths are estimated to be around 1 million, globally. Overall, PM 2.5 and O 3 -related premature mortality leads to 5.3–5.4 million premature deaths, globally. The global burden of premature deaths is mainly driven by the Asian region, which in 2015 contributes by 75% of the total global premature deaths. An increase from 6.2% to 8% in the PM 2.5 relative risk as recommended by the WHO leads to an increase of PM 2.5 -related premature mortality by 28%, to 5.7 million. Finally, bias correcting the simulated PM 2.5 concentrations in 2015 leads to an increase of up to 73% in the global PM 2.5 -related premature mortality, leading to a total number of global premature deaths of up to 7.7 million, implying the necessity of bias correction to get more robust health burden estimates. PM 2.5 and O 3 -related premature mortality in 2050 decreases by up to 57% and 18%, respectively, due to emission reductions alone. However, the projected increase and aging of the population leads to increases of premature mortality by up to a factor of 2, showing that the population exposed to air pollution is more important than the level of air pollutants, highlighting that the population dynamics should be considered when setting up health assessment systems.

Premature mortality↗

DOE OSTI2024

GAINN: The Galaxy Assembly and Interaction Neural Networks for High-redshift JWST Observations

We present the Galaxy Assembly and Interaction Neural Networks (Gainn), a series of artificial neural networks for predicting the redshift, stellar mass, halo mass, and mass-weighted age of simulated galaxies based on James Webb Space Telescope (JWST) photometry. Our goal is to determine the best neural network for predicting these variables at 11 < z < 15. The parameters of the optimal neural network can then be used to estimate these variables for real, observed galaxies. The inputs of the neural networks are JWST filter magnitudes of a subset of five broadband filters (F150W, F200W, F277W, F356W, and F444W) and two medium-band filters (F162M and F182M). We compare the performance of the neural networks using different combinations of these filters, as well as different activation functions and numbers of layers. The best neural network predicted redshift with a normalized rms error of $0.010^{+0.003}_{-0.001}$, stellar mass with rms = $0.089^{+0.044}_{-0.022}$, halo mass with a mean-squared error of $0.022^{+0.014}_{-0.008}$, and mass-weighted age with rms = $12.466^{+5.065}_{-2.408}$. We also test the performance of Gainn on real data from MACS0647JD, an object observed by JWST. Predictions from Gainn for the first projection of the object (JD1) have normalized bias $\langle$Δz$\rangle$ < 0.00228, which is significantly smaller than found with template-fitting methods. We find that the optimal filter combination is F277W, F356W, F162M, and F200W when considering both theoretical accuracy and observational resources from JWST.

97 MATHEMATICS AND COMPUTING↗

NASA NTRS1994

HST photometry of the trapezium cluster

We have obtained images of 11 fields in the Trapezium cluster with the Planetary Camera (PC) of the Hubble Space Telescope (HST) in order to extend Herbig & Terndrup's (1986) study of this prototype, dense embedded cluster to fainter magnitudes than is possible from the ground. Using these images, we have identified 319 stars within an area of approximately 12 sq arc min corresponding roughly to a volume of approximately 0.065 cu pc assuming the cluster is approximately spherically symmetric. Our completeness limits for star identification in V-band and I-band images are V approximately = 20 and I(sub c) approximately = 19 respectively, corresponding to a mass limit of approximately 0.15 solar mass if the faintest stars have the same average A(sub v) as that estimated for the brighter stars in the cluster. We have compared the V versus V-I color-magnitude diagram derived from the HST photometry to new theoretical isochrones. Star formation in the Trapezium appears to be remarkably coeval, with greater than or = 80% of the stars having inferred ages less than 1 Myr. Over the somewhat limited mass range of the observations, there is no evidence for 'bimodal' star formation-the high- and low-mass stars appear to have the same ages. The sharp cores of the HST images and the small angular size of the PC pixels has allowed us to identify 35 new visual binaries in the cluster with separations from approximately 0.06 arc sec (approximately 26 AU) to approximately 1.0 arc sec (approximately 440 AU). For the range of binary separations that we are sensitive to, the observed binary frequency for the Trapezium is essentially identical to that estimated for field low-mass stars by Duquennoy & Mayor (1991). The most straightfoward inference from this result is that binaries in this separation are unlikely to be formed by a tidal capture process. We have also identified three stars which have associated compact nebulosity visible in the HST images. One of these star + nebulosity cases was previously identified by O'Dell, Wen, & Hu (1993)-these objects appear to form a class of objects whose circumstellar matter is being 'lit up', most likely by Theta(sup 1) Ori C, enabling the gas to be observable at both optical and radio wavelengths (Felli et al. 1993a, b). We provide a brief summary of the optical properties of the other radio sources which appear in our PC images.

Prosser, Charles F.↗

NASA NTRS2011

Uncertainty Analysis in Space Radiation Protection

Space radiation is comprised of high energy and charge (HZE) nuclei, protons, and secondary radiation including neutrons. The uncertainties in estimating the health risks from galactic cosmic rays (GCR) are a major limitation to the length of space missions, the evaluation of potential risk mitigation approaches, and application of the As Low As Reasonably Achievable (ALARA) principle. For long duration space missio ns, risks may approach radiation exposure limits, therefore the uncertainties in risk projections become a major safety concern and methodologies used for ground-based works are not deemed to be sufficient. NASA limits astronaut exposures to a 3% risk of exposure induced death (REID) and protects against uncertainties in risks projections using an assessment of 95% confidence intervals in the projection model. We discuss NASA s approach to space radiation uncertainty assessments and applications for the International Space Station (ISS) program and design studies of future missions to Mars and other destinations. Several features of NASA s approach will be discussed. Radiation quality descriptions are based on the properties of radiation tracks rather than LET with probability distribution functions (PDF) for uncertainties derived from radiobiology experiments at particle accelerators. The application of age and gender specific models for individual astronauts is described. Because more than 90% of astronauts are never-smokers, an alternative risk calculation for never-smokers is used and will be compared to estimates for an average U.S. population. Because of the high energies of the GCR limits the benefits of shielding and the limited role expected for pharmaceutical countermeasures, uncertainty reduction continues to be the optimal approach to improve radiation safety for space missions.

Cucinotta, Francis A.↗

DOE OSTI2025

HIV drug resistance during antiretroviral therapy scale-up in Uganda, 2012–19: a population-based, longitudinal study

Background With scale-up of antiretroviral therapy (ART) in sub-Saharan Africa, increasing pretreatment HIV drug resistance has been reported; however, the broader effect of ART expansion on population-level resistance patterns remains insufficiently quantified. We aimed to estimate the longitudinal prevalence of drug resistance and resistance-conferring mutations. Methods This study used data collected as part of the Rakai Community Cohort Study (RCCS), an open population-based census and cohort study conducted in southern Uganda. At each survey round, residents aged 15–49 years are invited to participate and receive a structured questionnaire that obtains sociodemographic, behavioural, and health information, including self-reported past and current ART use. Voluntary HIV testing is conducted using a rapid test algorithm and a venous blood sample. People with HIV provide samples for viral load quantification and deep sequencing. We analysed RCCS survey, HIV viral load, and deep sequencing (which was used to predict resistance) data from five survey rounds. The key outcomes were the population prevalence of viraemic people with HIV with non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), protease inhibitor, or multiclass resistance among all participants (regardless of HIV serostatus) in the 2015 and 2017 surveys. Prevalence of class-specific resistance and resistance-conferring substitutions were estimated using robust log-Poisson regression. Findings Between Aug 10, 2011, and Nov 4, 2020, there were 43 361 participants in the RCCS and 7923 (18·27%) people with HIV. Over five survey rounds, 93 622 participant visits occurred, among which 17 460 (18·65%) were from people with HIV. Over the analysis period, the median age of study participants remained similar (28 years [22–35] in 2012 and 29 years [21–38] in 2019). Sufficient data were available to reliably genotype 4072 (90·03%) of 4523 participant visits from 3407 people with HIV for at least one drug. Overall population prevalence of resistance contributed by viraemic pretreatment people with HIV decreased between 2012 and 2017 from 0·56% (95% CI 0·42–0·75) to 0·25% (0·18–0·33) for NNRTI and from 0·24% (0·15–0·37) to 0·05% (0·02–0·10) for NRTI (prevalence ratio 0·44 [0·29–0·68] for NNRTI and 0·21 [0·09–0·47] for NRTI). Between 2012 and 2017, NNRTI resistance among viraemic pretreatment people with HIV increased from 4·86% (3·69–6·42) to 9·61% (7·27–12·7; prevalence ratio 1·98 [1·34–2·91]). The prevalence of NNRTI and NRTI resistance was substantially higher among viraemic treatment-experienced people with HIV (51·49% [46·24–57·34] for NNRTI and 36·46% [30·06–44·22] for NRTI in 2017) than among pretreatment people with HIV. NNRTI and NRTI resistance was predominantly attributable to rtK103N and rtM184V. inT97A was observed at a similar prevalence among viraemic treatment-experienced (9·96% [6·41–15·48]) and viraemic pretreatment (10·56% [8·01–13·93]) people with HIV; no major dolutegravir resistance mutations were observed. Interpretation Despite rising NNRTI resistance among pretreatment people with HIV, overall population prevalence of pretreatment HIV drug-resistant viraemia decreased due to increasing ART uptake and viral suppression. This finding underscores the crucial role of achieving and maintaining high ART coverage in reducing transmission of drug-resistant HIV. The high prevalence of mutations conferring resistance to components of first-line ART regimens among viraemic people with HIV is potentially concerning. Funding National Institutes of Health, Johns Hopkins University Center for AIDS Research, Bill & Melinda Gates Foundation, and the US Centers for Disease Control and Prevention.

59 BASIC BIOLOGICAL SCIENCES↗