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The Sims 4 is an upcoming life simulation game. It will be the fourth installment in The Sims series. Electronic Arts announced the game on May 6, 2013, and it is scheduled to be released for Microsoft Windows on September 2, 2014. A Mac release has been confirmed, but a date has not yet been announced, and there are currently no plans for a console release. The game has the same concept as its predecessor, The Sims 3. Players control their Sims in various activities and form relationships.

The game, like the rest of the series, does not have a defined final goal; gameplay is nonlinear. The Create a Sim and Build Mode tools have been redesigned to allow more versatility when creating game content. Emotional state plays a larger role in gameplay than in previous games in the series, with effects on social interaction, user interface, and personality. Create a Sim Create a Sim is revitalized, making it more intuitive and flexible than in previous games.

Stata/MP is a version of Stata/SE that runs on multicore and multiprocessor computers. Stata/MP provides the most extensive support for multicore computers and multiprocessor computers of any statistics and data management package.

Sims' physical features are customized by clicking-and-dragging on different parts of the body. Overall body size and amount of muscle are adjusted by sliders, but the size and shape of individual body parts can be adjusted individually, allowing players to make Sims with unique body shapes. Sims' facial features are also customized by the same click-and-drag mechanic. There is also a 'detail mode,' which allows more precise modification of certain facial features.

All changes made to one side of the body or head are automatically made to the opposite side. Emotions Sims in The Sims 4 have more emotional depth than in any previous game in the series. A Sims' emotional state affects which actions they perform and how the actions are performed. One Sim's emotions can affect other Sims around them. Sims in extreme emotional states can even be killed by their emotions.

The emotions that a Sim can or will experience are affected by their moodlets, traits, and life stage. In-game Gallery The gallery is an in-game exchange feature, allowing players to share their Sims, families, and buildings with other Sims players. Players can add their creations to the gallery, or pull other player creations into their game with just a couple mouse clicks.

The gallery is fully integrated into The Sims 4; everything added to the game through the gallery is immediately playable, without the need to restart the game. Build mode The Sims 4 features a revitalized, room-based build mode. Rooms are placed down then stretched in all directions until they are the proper size and shape. Rooms and entire houses can be picked up and moved around the lot, including all objects, floor and wall coverings, doors and windows. The Sims 4 improves upon the blueprint mode of The Sims 3, allowing players to place down fully-furnished rooms in a variety of styles; these rooms can then be resized, moved and adjusted as well. Players can also upload their rooms to the Gallery or download rooms from the Gallery to add to houses.

Several pre-existing build mode features have also been updated. Walls now have one of three different heights, set on each individual level of a building.Windows placed on walls can be moved up or down vertically along the wall. Windows can be automatically added to rooms, then adjusted by the player as needed. Columns automatically stretch or contract to match the height of the walls on a particular level, and can be added to railings without the use of themoveobjects cheat.

Foundations are no longer treated as separate levels on a building. Foundations can be added to or removed from a building, even if the building is already built, and the height of the foundation can be adjusted.

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HIV/AIDS, global health and the Sustainable Development Goals K De Cock CDC Country Office, US Centers for Disease Control and Prevention, Nairobi, Kenya Sustainable Goal (SDG) 3 calls for an end to the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases by 2030, and the concomitant UNAIDS Fast‐Track Strategy aims to reduce new HIV infections to no more than 500,000 annually by 2020 and 200,000 by 2030. Central to the global effort is the UNAIDS 90‐90‐90 initiative which requires 90% of persons with HIV to be diagnosed, 90% of those to receive ART and 90% of the treated to be virally suppressed. There is controversy around how “the end of AIDS” is defined, about whether this ambitious goal is achievable and whether AIDS exceptionalism is still appropriate. UNAIDS has targeted 30 million people to be on ART by 2020, when fiscal requirements are expected to be 26 billion US dollars annually; current expenditure is about 7 billion US dollars less.

This presentation will review progress in the AIDS response in the overall context of current global health. It honours Jacqueline Van Tongeren and Joep Lange and their work, and is dedicated to their memory. Strategies to reduce HIV incidence in Europe A Pharris European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden HIV incidence is increasing in the European region as a whole, although there are large epidemiological differences between Western, Central and Eastern Europe. Whilst overall 80% of people in the European region have been diagnosed with HIV, this varies greatly across sub‐regions with 86%, 83% and 76% of people diagnosed in Western, Central and Eastern Europe respectively. Among those diagnosed, 64% are estimated to be on treatment and this, too, differs across the region with 90%, 73% and 46% of those diagnosed on treatment in Western, Central and Eastern sub‐regions, respectively. Among those on treatment in the European region, 85% are virally suppressed with variations across sub‐regions in Europe (92%, 78% and 74% in Western, Central and Eastern).

Within sub‐regions and among key populations within countries there is considerable diversity in diagnosis, proportion on treatment and viral suppression rates. While some countries within the region have been successful in meeting and surpassing the 90‐90‐90 targets, others are facing enormous challenges and are lagging behind. While the tools to prevent HIV – including diversified testing strategies, treatment as prevention, PrEP and harm reduction – have multiplied in recent years, their application across Europe is uneven and, in most settings, far lower than needed to impact incidence. Differences in epidemiology of HIV and health systems across Europe necessitate context‐specific strategies to strengthen and control HIV prevention and care efforts. PrEP: what's happening in Europe and the world in general S McCormack MRC Clinical Trials Unit, University College London, London, UK Within and beyond Europe, PrEP is undoubtedly contributing to the decline in new diagnoses reported in gay and other MSM, but the public health benefit is difficult to assess precisely and the impressive decline seen in some city clinics is not universal. San Francisco, central London and New South Wales have seen the largest gains. In all these settings testing and treatment were already at scale when PrEP was introduced.

The contribution of PrEP to the toolkit is most accurately captured in New South Wales where they observed a 35% reduction in state‐wide new HIV diagnoses in MSM following rapid scale‐up of PrEP in the EPIC trial, two seroconversions amongst 3927 years of follow‐up amongst trial participants 1. TDF/FTC PrEP is extremely effective biologically, but it is costly and needs to be delivered as part of a comprehensive package of interventions to reduce the risk of sexually transmitted infections including HIV – a package that is not available to everyone in Europe or globally in spite of the current burden of sexually transmitted infections. Introducing PrEP is therefore an opportunity to strengthen prevention services, and one of the most cost‐efficient methods is to employ key populations to deliver services when and where convenient to eligible peers (AIDS 2018). Adherence remains the Achilles heel for PrEP, and the products in the pipeline may go some way to addressing this: vaginal rings, long‐acting injectables and implants. However, first and foremost is the need to empower key populations with the information they need to understand their risk of HIV/STIs and how to reduce this during the various phases of their sexual lifetime. Retention and re‐engagement in care: a combination approach again required F Burns Centre for Sexual Health and HIV Research, and Royal Free Hospital, London, UK Effective ART remains the cornerstone of successful HIV management, with life expectancy in those successfully treated similar to that of the general population. ART is also an effective means of reducing population HIV transmission with the goal of zero new infections.

However, suboptimal engagement in HIV care threatens to derail this success and is associated with serious consequences for both individual and public health. Engagement in care for any individual is dynamic and disengagement may happen at any time. Indeed, in the UK as many as one in four HIV clinic appointments are missed. While ‘living well with HIV’ is the current mantra, it is still denied to many. The population groups most at risk of disengagement are invariably those most marginalised and with the least advocacy. They include people who struggle with HIV‐related stigma, those with insecure residency and/or employment and people living with mental health, alcohol and drug dependency issues – problems that may increase in the current political and economic environment.

Sustainable engagement will require a combination of biomedical, behavioural and structural strategies that recognise and address individual level factors and create a more enabling environment for health over the life course. Community participation and partnership in this process will be vital, with peer and social support services playing a key role. To tailor and target interventions appropriately, mechanisms are needed to predict those at risk of subsequent disengagement as well to respond once this occurs. Effective mechanisms for predicting and monitoring engagement are either limited or lacking, and the pool of evidence‐based interventions to improve engagement small. Future investment in research and services to tackle engagement is required to ensure the health inequalities we see across our cohorts reduced. HIV and aging: challenges and goals J Falutz Department of Medicine, McGill University, Montreal, Canada Currently, overall long‐term survival of treated PLWHIV world‐wide approaches that of the general population. An increasing minority will live as long as their seronegative peers.

As a result, the average age of PLWHIV, currently in the mid‐50s in resource‐rich countries, has increased. The proportion of older PLWHIV who are long‐term survivors compared to those who seroconvert at an older age varies according to local factors.

The salutary impact on survival has nevertheless been challenged by several developments. The increasing proportion of PLWHIV approaching a typical geriatric age range will significantly impact health care delivery; their clinical features are similar to that of the general population about 5 to 10 years older. In addition to the earlier occurrence of common age‐related conditions, with increased multimorbidity compared to controls, several common geriatric syndromes have also impacted this younger population.

These often difficult‐to‐evaluate and ‐manage conditions may include: sarcopenia, impaired mobility and falls, sensory complaints (neuropathy, visual and auditory deficits), cognitive decline and, significantly, frailty. This latter condition, a state of increased vulnerability to biologic and environmental stressors, with reduced ability to maintain homeostasis, remains challenging to evaluate and operationalize. In the general population, a simple and reliable metric to diagnose frailty in the usual clinical setting remains elusive. This is compounded by the poorly understood biologic basis for frailty, distinct from its increased risk of concurrent disabilities and comorbidities.

Research into common determinants of frailty between the geriatric population and PLWHIV related to immune‐senescence, chronic inflammation, epigenetics and mitochondriopathy provide clues to potential avenues for prevention and management. Frailty may be key to understanding the discordance between chronologic and biologic age. Concurrently, investigation of predictors of successful aging in PLWHIV is progressing. Insights into the concepts of both psychological and physical resilience in seronegatives may be an important bridge contributing not only to increased lifespan but also to improved health‐span for PLWHIV.

Risk of hospitalisation according to gender, sexuality and ethnicity among people with HIV in the modern ART era S Rein 1, F Lampe 1, M Johnson 2, C Chaloner 1, F Burns 1, S Madge 2, A Phillips 1, C Smith 1 1Institute for Global Health, University College London, London, UK. 2HIV Medicine, Royal Free Hampstead NHS Trust, London, UK Background: There has been little research on the impact of gender and sexual orientation on hospitalisations in HIV‐positive people in the UK in the modern ART era. Materials and methods: All HIV‐diagnosed individuals attending the Royal Free Hospital, London, from 2007 onwards were followed until 2016. Rates of all‐cause hospitalisation in the first year after diagnosis (analysis A) and from Year 1 onwards (analysis B) were calculated according to gender/sexuality/ethnicity and adjusted for demographic and clinical factors using Cox and Poisson regression respectively. Repeated hospitalisations were permitted in analysis B. Results: For analysis A, 166 hospitalisations occurred in 1307 newly‐diagnosed individuals.

Forty‐four percent, 55% and 46% of hospitalisations in MSM, men who have sex with women (MSW) and women were AIDS‐related. The higher hospitalisation rate in MSW and women compared to MSM was only partially explained by CD4 count and other factors (Table 1). Lower CD4, older age and earlier diagnosis date were independently associated with higher hospitalisation rate. For analysis B, 4211 individuals diagnosed for 1 year contributed 773 hospitalisations from 553 individuals. Seven percent, 18% and 10% of hospitalisations in MSM, MSW and women were AIDS‐related. Non‐Black MSW and women remained at higher risk of hospitalisation, but the association was weaker than that seen in the first year after diagnosis (Table 1). Lack of viral suppression, lower CD4, older age and earlier diagnosis date were also independently associated with hospitalisations.

All p values. Multimorbidity and risk of death differs by gender in people living with HIV in the Netherlands: the ATHENA cohort study F Wit 1, M van der Valk 2, J Gisolf 3, W Bierman 4, P Reiss 2 1Stichting HIV Monitoring, Academic Medical Center, Amsterdam, Netherlands. 2Department of Internal Medicine, Academic Medical Center, Amsterdam, Netherlands. 3Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, Netherlands.

4Department of Internal Medicine – Infectious Diseases, University Medical Center Groningen, Groningen, Netherlands Background: PLWHIV on cART are living longer and because of ageing are experiencing more non‐AIDS comorbidities, which have become the most common cause of death in PLWHIV on cART. We investigated if multimorbidity predicts mortality in PLWHIV on cART and whether this differs by gender.

Materials and methods: We used data from PLWHIV from the ATHENA cohort collected from 2000 to 2016. Comorbidities identified were: cardiovascular disease; stroke; non‐AIDS malignancies, excluding non‐melanoma skin cancers and pre‐malignant cervical/anal lesions; moderate‐severe chronic kidney disease (eGFR 30).

Poisson regression compared mortality between genders adjusting for demographics, traditional risk factors and HIV‐related parameters. Results: Data from 24,383 PLWHIV (19.2% females) were included (see Table 1). At cART initiation the mean number of non‐AIDS comorbidities in males (0.26) and females (0.25) were similar ( p = 0.34). At last available follow‐up in 2016 the mean number of comorbidities had increased in both males (0.59) and females (0.59), p = 0.18. Mortality risk increased with number of comorbidities, from 6.83 deaths per 1000 person‐years in PLWHIV with zero comorbidities, to 13.8, 28.2, 65.6 and 139 per 1000 person‐years with 1, 2, 3, ≥4 comorbidities, respectively. Poisson regression confirmed the relationship between multimorbidity and mortality: risk ratio (RR) 2.66 (2.54 to 2.79) per additional comorbidity. Overall mortality risk, adjusted for the number of comorbidities, was significantly lower in women than men (RR 0.78 0.67 to 0.91, p = 0.002).

However, there was a significant interaction between gender, number of comorbidities and mortality ( p. Females Males p value Characteristics at entry into the cohort Number of participants 4687 (19.2%) 19,696 (80.8%) ‐ Age 33.5 (27.7 to 40.9) 39.3 (32.5 to 47.1).