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OBJECTIVES/SPECIFIC AIMS: The National HIV/AIDS strategy aims to increase retention in care (RIC) to reduce HIV transmission and mortality. Previous studies have evaluated clinic-level interventions such as appointment reminders and peer navigation. However, few studies have investigated the association between multiple clinic-level factors and RIC among PLWH across the United States. We conducted a multi-site cohort study to identify clinic-level factors associated with RIC in the United States from 2010-2016. METHODS/STUDY POPULATION: We included PLWH with at least one HIV primary care visit from 2010-2016 at seven sites of the Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS). Individual-level data collected as part of routine clinical care were abstracted from the electronic health record. Clinic-level data were gathered through a survey and included questions on site characteristics (i.e. clinic volume) as well as services available at the site during each year of the study: peer navigation, RIC posters/brochures, laboratory test timing, flexible scheduling, appointment reminder types, and stigma support services defined as intensive HIV education and advocacy regarding support to address stigma at outreach visits. RIC was defined as ≥2 encounters per year, ≥90 days apart, observed until death, administrative censoring (December 31, 2016), or loss to follow-up (no visit for >12 months with no future visits). Poisson panel regression with robust error variance, clustering by site and adjusting for calendar year, age (modeled with a cubic spline), sex, race/ethnicity, and HIV transmission risk factor, was used to estimate incident rate ratios (IRR) with 95% confidence intervals (CI) for RIC. Clustering by site has been shown to absorb for clustering that could occur at the individual level as well. RESULTS/ANTICIPATED RESULTS: Among 21,046 patients contributing 103,348 person-years, 67% of person-years were RIC. Text appointment reminders (IRR = 1.13; 95% CI: 1.03-1.24) and stigma support services (IRR=1.11; 95% CI:1.04-1.19) were significantly associated with RIC. RIC disparities in individual-level patient characteristics were observed even after accounting for clinic-level characteristics. Older patients were more likely to be RIC demonstrated through year comparisons due to the use of a spline; for age 50 years (IRR = 1.07, 95% CI: 1.06-1.08) and 60 years (IRR = 1.15, 95% CI: 1.13-1.17) compared to 45 years. Female PLWH were more likely to be RIC compared to males (IRR = 1.03, 95% CI: 1.02-1.05) and Hispanic PLWH were more likely to be RIC compared to white, non-Hispanic PLWH (IRR = 1.09, 95% CI: 1.05-1.13). Although commonly found to be associated with worse RIC, Black race and injection drug use were not associated with RIC in this population. DISCUSSION/SIGNIFICANCE OF IMPACT: In this multi-site US cohort study from 2010-2016, availability of text appointment reminders and stigma support services at a clinic were associated with approximately 10% higher probability of RIC than at clinics without those services. RIC disparities persisted with respect to individual-level characteristics of age, sex, and race/ethnicity even after accounting for these clinic-level factors. Prospective studies examining the impact of these clinic-level factors and individual-level uptake of these services on RIC are needed.
We evaluated the impact of the Epic antimicrobial stewardship module (EAM) on the number of interventions, antimicrobial usage, and clinical outcomes. Use of the EAM allowed us to significantly increase the number of ASP antimicrobial reviews and interventions while maintaining a sustained impact on antimicrobial utilization.
Glaciers spanning large altitudinal ranges often experience different climatic regimes with elevation, creating challenges in acquiring mass-balance and climate observations that represent the entire glacier. We use mixed methods to reconstruct the 1991–2014 mass balance of the Kahiltna Glacier in Alaska, a large (503 km2) glacier with one of the greatest elevation ranges globally (264–6108 m a.s.l.). We calibrate an enhanced temperature index model to glacier-wide mass balances from repeat laser altimetry and point observations, finding a mean net mass-balance rate of −0.74 mw.e. a−1( ± σ = 0.04, std dev. of the best-performing model simulations). Results are validated against mass changes from NASA's Gravity Recovery and Climate Experiment (GRACE) satellites, a novel approach at the individual glacier scale. Correlation is strong between the detrended model- and GRACE-derived mass change time series (R2 = 0.58 and p ≪ 0.001), and between summer (R2 = 0.69 and p = 0.003) and annual (R2 = 0.63 and p = 0.006) balances, lending greater confidence to our modeling results. We find poor correlation, however, between modeled glacier-wide balances and recent single-stake monitoring. Finally, we make recommendations for monitoring glaciers with extreme altitudinal ranges, including characterizing precipitation via snow radar profiling.
Research shows that childhood dysregulation is associated with later psychiatric disorders. It does not yet resolve discrepancies in the operationalization of dysregulation. It is also far from settled on the origins and implications of individual differences in dysregulation. This study tested several operational definitions of dysregulation using Achenbach attention, anxious/depressed, and aggression subscales. Individual growth curves of dysregulation were computed, and predictors of growth differences were considered. The study also compared the predictive utility of the dysregulation indexes to standard externalizing and internalizing indexes. Dysregulation was indexed annually for 24 years in a community sample (n = 585). Hierarchical linear models considered changes in dysregulation in relation to possible influences from parenting, family stress, child temperament, language, and peer relations. In a test of the meaning of dysregulation, it was related to functional and psychiatric outcomes in adulthood. Dysregulation predictions were further compared to those of the more standard internalizing and externalizing indexes. Growth curve analyses showed strong stability of dysregulation. Initial levels of dysregulation were predicted by temperamental resistance to control, and change in dysregulation was predicted by poor language ability and peer relations. Dysregulation and externalizing problems were associated with negative adult outcomes to a similar extent.
If an ice sheet is frozen to its bed, deep ice directly under a divide experiences low deviatoric stress and is relatively hard, because the rheology of polar ice is described by a power-law constitutive relation. In steady state, stratigraphic layers tend to form an arch (“Raymond bump”) in this region. However, when the basal ice can slide, the stresses are redistributed, and longitudinal extension due to sliding is associated with increased deviatoric stress in the deep ice under the divide. This increased deviatoric stress weakens the tendency to form a Raymond bump. To find a realistic spatial distribution of sliding under an ice divide, we incorporate a thin layer of viscous till in a finite-element plane-strain flow model. The resulting basal “sliding” velocity varies approximately linearly with distance from the ice divide. By varying the till viscosity, we can adjust the amount of basal motion. We find that the Raymond bump decays exponentially with the fraction of total ice flux carried by sliding: the arch is 50% smaller when the sliding flux is only 7% of the total ice flux. This implies that the possibility of a wet bed must be considered when inferring past ice-divide locations from radar internal layering.
Conventional and reference-surface mass-balance data from Gulkana and Wolverine Glaciers, Alaska, USA, are used to address the questions of how rapidly these glaciers are adjusting (or ‘responding’) to climate, whether their responses are stable, and whether the glaciers are likely to survive in today’s climate. Instability means that a glacier will eventually vanish, or at least become greatly reduced in volume, if the climate stabilizes at its present state. A simple non-linear theory of response is presented for the analysis. The response of Gulkana Glacier is characterized by a timescale of several decades, but its stability and therefore its survival in today’s climate are uncertain. Wolverine seems to be responding to climate more slowly, on the timescale of one to several centuries. Its stability is also uncertain, but a slower response time would make it more susceptible to climate changes.
Direct measurements of processes occurring at the ice–ocean boundary are difficult to acquire because of the dangerous and dynamic nature of the boundary, yet these processes are among the least well understood in glaciology. Because sound travels well through water, passive underwater acoustics offers a method to remotely sense activity at this boundary. Here we present passive acoustic measurements and spectral analysis of the evolution of a subaerial calving event and the subsequent mini-tsunami and seiche at Meares Glacier, Alaska, USA. Using two hydrophones to record sound from 1 to 40 000 Hz, we find that each phase of a calving event has distinctive spectral characteristics. An event begins with an infrasound rumble (1–20 Hz), then the ice fractures (20–100 Hz), falls and impacts the water (200–600 Hz). High-frequency (>10 000 Hz) sound increases in intensity quickly as the iceberg oscillates, creating turbulence, spray and waves. Within 10 s, the low-frequency audible sound dissipates and the mini-tsunami and seiche sounds dominate (infrasound plus high frequencies) and continue for over 10 min. The specific frequencies and duration of each phase of a calving event depend on its size and location and the glacier and fjord characteristics.
Polycrystalline ice near an ice divide typically shows a crystal fabric (crystal preferred orientation) with c axes clustered vertically. We explore the effect of this fabric on the large-scale flow pattern near an ice divide. We incorporate an analytical formulation for anisotropy into a non-linear flow law within a finite-element ice-sheet flow model. With four different depth profiles of crystal fabric, we find that the effect of fabric is significant only when a profile has a minimum cone angle of less than ~25º. For a steady-state divide, the shape and size of the isochrone arch can depend as much on the crystal fabric as it does on the non-linearity of ice flow. A vertically oriented fabric tends to increase the size of the isochrone arch, never to reduce it. Also, non-random fabric has little effect on the ice-divide-flow pattern when ice is modeled as a linear (Newtonian) fluid. Finally, when we use a crystal-fabric profile that closely approximates the measured profile for Siple Dome, West Antarctica, the model predicts concentrated bed-parallel shearing 300 m above the bed.
As part of a project to investigate the flow of ice at low effective stress, two independent strain-gauge systems were used to measure vertical strain rate as a function of depth and time at Siple Dome, Antarctica. The measurements were made from January 1998 until January 2002 at the ice divide and a site 7km to the northeast on the flank. The strain-rate profiles place constraints on the rheology of ice at low stress, show the expected differences between divide and flank flow (with some structure due to firn compaction and probably ice stratigraphy), and suggest that the flow of the ice sheet has not changed much in the last 8.6 kyr. The strain rates show an unexpected time dependence on scales ranging from several months to hours, including discrete summer events at the divide. Time dependence in strain rate, water pressure, seismicity, velocity and possibly basal motion has been seen previously on the Siple Coast ice streams, but it is especially surprising on Siple Dome because the bed is cold.
We use optical (ASTER and Landsat) and radar (ERS-1 and ERS-2) satellite imagery to document changes in the Prince Gustav Ice Shelf, Antarctic Peninsula, and its tributary glaciers before and after its January 1995 collapse. The satellite image record captures the transition from an ice-shelf glacier system to a tidewater glacial system and the subsequent rapid retreat and inferred ‘fatal’ negative mass balances that occur as lower glacier elevations lead to higher ablation and tidewater-style calving collapse. Pre-1995 images show that the central ice shelf was fed primarily by Sjögren Glacier flowing from the Antarctic Peninsula and by Röhss Glacier flowing from James Ross Island. Numerous structural discontinuities (rifts and crevasses) and melt ponds were present on the ice shelf before the collapse. After the ice shelf collapsed, Röhss Glacier retreated rapidly, becoming a tidewater glacier in 2002 and receding a total of ∼15 km between January 2001 and March 2009, losing >70% of its area. Topographic profiles of Röhss Glacier from ASTER-derived digital elevation models show a thinning of up to ∼150 m, and surface speeds increased up to ninefold (0.1–0.9 m d−1) over the same period. The rates of speed increase and elevation loss, however, are not monotonic; both rates slowed between late 2002 and 2005, accelerated in 2006 and slowed again in 2008–09. We conclude that tributary glaciers react to ice-shelf removal by rapid (if discontinuous) recession, and that the response of tidewater glaciers on the Antarctic Peninsula to ice-shelf removal occurs over timescales ranging from sub-annual to decadal.
We used observations and modeling of Siple Dome, West Antarctica, a ridge ice divide, to infer the importance of linear deformation mechanisms in ice-sheet flow. We determined the crossover stress (a threshold value of the effective deviatoric stress below which linear flow mechanisms dominate over nonlinear flow mechanisms) by combining measurements of ice properties with in situ deformation rate measurements and a finite-element ice flow model that accounts for the effects of viscous anisotropy induced by preferred crystal-orientation fabric. We found that a crossover stress of 0.18 bar produces the best match between predicted and observed deformation rates. For Siple Dome, this means that including a linear term in the flow law is necessary, but generally the flow is still dominated by the nonlinear (Glen; n = 3) term. The pattern of flow near the divide at Siple Dome is also strongly affected by crystal fabric. Measurements of sonic velocity, which is a proxy for vertically oriented crystal fabric, suggest that a bed-parallel shear band exists several hundred meters above the bed within the Ice Age ice.
The effective viscosity of ice depends upon many factors, including temperature, deviatoric stress, crystal orientation and impurities. A flow law that includes these factors and is simple to implement is a requirement for numerically efficient ice-flow models. The dominant microscale flow mechanism changes as temperature, deviatoric stress or grain-size changes. For both anisotropic and isotropic constitutive relations, this shift in dominant flow mechanism is expressed as a change in the stress exponent. We study the effects of this shift in stress exponent on ice flow using a two-term flow law for isotropic ice. Our stress–strain-rate relationship does not explicitly describe the microscale processes of ice deformation; however, it encompasses a range of deformation behaviors with a simple law. In terrestrial ice, a flow-mechanism shift may occur in low-deviatoric-stress regions near ice divides, resulting in a near-linear constitutive relationship for ice flow. Compared to a non-linear (Glen) divide, a divide dominated by a near-linear flow mechanism has vertical-velocity profiles that are similar at divide and flank sites, internal layers that do not develop a Raymond bump, and a steady-state surface profile that is more rounded near the divide.
A 141m ice core was recovered from Combatant Col (51.385° N, 125.258° W; 3000ma.s.l.), Mount Waddington, Coast Mountains, British Columbia, Canada. Records of black carbon, dust, lead and water stable isotopes demonstrate that unambiguous seasonality is preserved throughout the core, despite summer surface snowmelt and temperate ice. High accumulation rates at the site (>4 m ice eq. a-1) limit modification of annual stratigraphy by percolation of surface meltwater. The ice-core record spans the period 1973–2010. An annually averaged time series of lead concentrations from the core correlates well with historical records of lead emission from North America, and with ice-core records of lead from the Greenland ice sheet. The depth-age scale for the ice core provides sufficient constraint on the vertical strain to allow estimation of the age of the ice at bedrock. Total ice thickness at Combatant Col is ~250 m; an ice core to bedrock would likely contain ice in excess of 200 years in age. Accumulation at Combatant Col is significantly correlated with both regional precipitation and large-scale geopotential height anomalies.
As part of a larger program to measure and model vertical strain around Siple Dome on the West Antarctic ice sheet, we developed a new sensor to accurately and stably record displacements. The sensors consist of optical fibers, encased in thin-wall stainless-steel tubes, frozen into holes drilled with hot water, and stretched from the surface to various depths (up to 985 m) in the ice sheet. An optical system, connected annually to the fibers, reads out their absolute lengths with a precision of about 2 mm. Two sets of five sensors were installed in the 1997/98 field season: one set is near the Siple Dome core hole (an ice divide), and a second set is on the flank 7 km to the north (the ice thickness at both sites is approximately 1000 m). The optical-fiber length observations taken in four field seasons spanning a 3 year interval reveal vertical strain rates ranging from −229 ± 4 ppm a−1 to −7 ± 9 ppm a−1. In addition to confirming a non-linear constitutive relationship for deep ice, our analysis of the strain rates indicates the ice sheet is thinning at the flank and is in steady state at the divide.
The evolution of preferred crystal-orientation fabrics is strongly sensitive to the initial fabric and texture. A perturbation in climate can induce variations in fabric and texture in the firn. Feedbacks between fabric evolution and ice deformation can enhance these variations through time and depth in an ice sheet. We model the evolution of fabric under vertical uniaxial-compression and pure-shear regimes typical of ice divides. Using an analytic anisotropic flow law applied to an aggregate of distinct ice crystals, the model evolves the fabric and includes parameterizations of crystal growth, polygonization and migration recrystallization. Stress and temperature history drive the fabric evolution. Using this model, we explore the evolution of a subtle variation in near-surface fabric using both constant applied stress and a stress–temperature history based on data from Taylor Dome, East Antarctica. Our model suggests that a subtle variation in fabric caused by climate perturbations will be preserved through time and depth in an ice sheet. The stress history and polygonization rate primarily control the magnitude of the preserved climate signal. These results offer the possibility of extracting information about past climate directly from ice fabrics.
At Taylor Glacier, a cold-based outlet glacier of the East Antarctic ice sheet, observed surface speeds in the terminus region are 20 times greater than those predicted using Glen’s flow law for cold (–17°C), thin (100 m) ice. Rheological properties of the clean meteoric glacier ice and the underlying deformable debris-rich basal ice can be inferred from surface-velocity and ablation-rate profiles using inverse theory. Here, with limited data, we use a two-layer flowband model to examine two end-member assumptions about the basal-ice properties: (1) uniform softness with spatially variable thickness and (2) uniform thickness with spatially variable softness. We find that the basal ice contributes 85–98% to the observed surface velocity in the terminus region. We also find that the basal-ice layer must be 10–15 m thick and 20–40 times softer than clean Holocene-age glacier ice in order to match the observations. Because significant deformation occurs in the basal ice, our inverse problem is not sensitive to variations in the softness of the meteoric ice. Our results suggest that despite low temperatures, highly deformable basal ice may dominate flow of cold-based glaciers and rheologically distinct layers should be incorporated in models of polar-glacier flow.
The observable microstructures in ice are the result of many dynamic and competing processes. These processes are influenced by climate variables in the firn. Layers deposited in different climate regimes may show variations in fabric which can persist deep into the ice sheet; fabric may ‘remember’ these past climate regimes. We model the evolution of fabric variations below the firn–ice transition and show that the addition of shear to compressive-stress regimes preserves the modeled fabric variations longer than compression-only regimes, because shear drives a positive feedback between crystal rotation and deformation. Even without shear, the modeled ice retains memory of the fabric variation for 200 ka in typical polar ice-sheet conditions. Our model shows that temperature affects how long the fabric variation is preserved, but only affects the strain-integrated fabric evolution profile when comparing results straddling the thermal-activation-energy threshold (∼−10°C). Even at high temperatures, migration recrystallization does not eliminate the modeled fabric’s memory under most conditions. High levels of nearest-neighbor interactions will, however, eliminate the modeled fabric’s memory more quickly than low levels of nearest-neighbor interactions. Ultimately, our model predicts that fabrics will retain memory of past climatic variations when subject to a wide variety of conditions found in polar ice sheets.