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Summary: In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.
Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of black vs. white ethnicity (odds ratio 9.08; 95% confidence interval 2.72–30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04–0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20–80.86 (Asian); 8.03, 95% CI 1.12–57.61 (black); and 8.11, 95% CI 1.13–58.18 (other/mixed)). Anti-HCV positivity was more likely among 36–55 year olds vs. ⩾56 years (7.69, 95% CI 2.24–26.41), and less likely among females (0.24, 95% CI 0.09–0.65). Persons positive for HIV-markers were more likely to be of black vs. white ethnicity (4.51, 95% CI 1.63–12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17–0.88), or female (0.12, 95% CI 0.04–0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.
Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of populations, but few studies to date have reported on MBCT for treatment of anxious and depressive symptoms in Parkinson's disease (PD). Aims: The aim of this study was to examine the efficacy of modified MBCT in reducing symptoms of anxiety and depression and improving quality of life in PD. Method: Thirty-six individuals with PD were randomly assigned to either modified MBCT or a waitlist control. Changes in symptoms of anxiety, depression and quality of life were compared at group level using generalized linear mixed models and at individual level using reliable change analysis. Results: At post-treatment, there was a significant reduction in depressive symptoms for people undertaking modified MBCT at both group and individual levels compared with controls. There was no significant effect on anxiety or quality of life at the group level, although significantly more people had reliable improvement in anxiety after modified MBCT than after waitlist. Significantly more waitlist participants had reliable deterioration in symptoms of anxiety and depression than those completing modified MBCT. Most participants stayed engaged in modified MBCT, with only three drop-outs. Discussion: This proof-of-concept study demonstrates the potential efficacy of modified MBCT as a treatment for depressive symptoms in Parkinson's disease and suggests further research is warranted.
All sectors of livestock production are in the process of shifting from small populations on many farms to large populations on fewer farms. A concurrent shift has occurred in the number of livestock moved across political boundaries. The unintended consequence of these changes has been the appearance of multifactorial diseases that are resistant to traditional methods of prevention and control. The need to understand complex animal health conditions mandates a shift toward the collection of longitudinal animal health data. Historically, collection of such data has frustrated and challenged animal health specialists. A promising trend in the evolution toward more efficient and effective livestock disease surveillance is the increased use of aggregate samples, e.g. bulk tank milk and oral fluid specimens. These sample types provide the means to monitor disease, estimate herd prevalence, and evaluate spatiotemporal trends in disease distribution. Thus, this article provides an overview of the use of bulk tank milk and pen-based oral fluids in the surveillance of livestock populations for infectious diseases.
The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood.
To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex.
The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013–2014).
Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17–1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20–1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19–1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33–2.50; P<0.001).
Management of mental health may play a role in HIV and STI prevention.
Diet can play a significant role in anomalous radiocarbon ages derived from bone and other tissues when the food web incorporates depleted 14C reservoirs, such as the marine environment. Dietary effects from a post-bomb carbon variation have also been found in modern invertebrates and populations of Rattus exulans (Beavan and Sparks 1998). We now present the effect on absolute percent modern (pMC) and the conventional radiocarbon age (CRA) of a modern aquatic/terrestrial food web in a volcanic zone of the North Island, New Zealand. At Lake Taupo, geothermal venting transfers 14C depleted carbon to lake waters, which aquatic plants fix into the food chain; depleted 14C is shown to then pass on to shellfish, waterfowl, and Norway rat (Rattus norvegicus). The geothermally induced 14C variations from modern atmospheric pMC and CRA can increase apparent 14C ages by >2000 years.
We have isolated amino acid groups from modern bone hydrolysates and compared their relative Δ14C value to assess the carbon contribution of diet to the overall radiocarbon signal in bone. We find that both essential and non-essential amino acids may produce widely varying 14C, relative to other amino acid groups in the hydrolysate and to the original whole bone protein. We hypothesize that the 14C variations in non-essential amino acids may be due to metabolic effects that utilize essential amino acid carbon skeletons in the creation of non-essential amino acids.
An isotopic database for the Pacific/Polynesian rat (Rattus exulans) and foods that it scavenges is used to examine diet-induced 14C age variation in omnivores. We discuss a suite of 26 δ14C determinations and 13C and 15N analysis for modern Pacific/Polynesian rat bone gelatin and available food items from Kapiti Island, New Zealand (40°51'S, 174°75'E). These analyses provide the first isotopic data for modern specimens of the species, collected as part of a larger project to determine potential sources of bias in unexpectedly old 14C age measurements on subfossil specimens of R. exulans from New Zealand. Stable C, N and 14C isotopic and trapping data are used to trace carbon intake via the diet of the rats in each habitat. Data from specimens linked to five specific habitats on the island indicate that modern populations of R. exulans are not in equilibrium with atmospheric values of δ14C, being either enriched or depleted relative to the atmospheric curve in 1996/97, the period of collection. The δ14C values recorded for R. exulans are associated with diet, and result from variation in δ14C values found in animal-protein food items available to a scavenging omnivore. The titer of carbon deviating from atmospheric values is believed to be derived from the essential amino acids in the protein-rich foods of the rat diet.
Present evidence suggests that the depletion required to affect 14C ages limits the possibility that diet introduces dramatic offsets from true ages. Marine diets, for example, would have a variable effect on ages for terrestrial omnivores, contraindicating the application of a standard marine correction for such specimens. We suggest that to identify the extent to which diet may influence the 14C age in a given specimen of terrestrial omnivore, the separation and dating of essential amino acids vs. a nonessential amino, such as glycine, be applied.
This book presents a wide range of new research on many aspects of naval strategy in the early modern and modern periods. Among the themes covered are the problems of naval manpower, the nature of naval leadership and naval officers, intelligence, naval training and education, and strategic thinking and planning. The book is notable for giving extensive consideration to navies other than those ofBritain, its empire and the United States. It explores a number of fascinating subjects including how financial difficulties frustrated the attempts by Louis XIV's ministers to build a strong navy; how the absence of centralised power in the Dutch Republic had important consequences for Dutch naval power; how Hitler's relationship with his admirals severely affected German naval strategy during the Second World War; and many more besides. The book is a Festschrift in honour of John B. Hattendorf, for more than thirty years Ernest J. King Professor of Maritime History at the US Naval War College and an influential figure in naval affairs worldwide.
N.A.M. Rodger is Senior Research Fellow at All Souls College, Oxford.
J. Ross Dancy is Assistant Professor of Military History at Sam Houston State University.
Benjamin Darnell is a D.Phil. candidate at New College, Oxford.
Evan Wilson is Caird Senior Research Fellow at the National Maritime Museum, Greenwich.
Contributors: Tim Benbow, Peter John Brobst, Jaap R. Bruijn, Olivier Chaline, J. Ross Dancy, Benjamin Darnell, James Goldrick, Agustín Guimerá, Paul Kennedy, Keizo Kitagawa, Roger Knight, Andrew D. Lambert, George C. Peden, Carla Rahn Phillips, Werner Rahn, Paul M. Ramsey, Duncan Redford, N.A.M. Rodger, Jakob Seerup, Matthew S. Seligmann, Geoffrey Till, Evan Wilson
Real-time detection of microlensing has moved from proof of concept in 1994 (Udalski et al. 1994a, Alcock et al. 1994) to a steady stream of events this year. Global dissemination of these events by the MACHO and OGLE collaborations has made possible intensive photometric and spectroscopic follow up from widely dispersed sites confirming the microlensing hypothesis (Benetti 1995). Improved photometry and increased temporal resolution from follow up observations greatly increases the possibility of detecting deviations from the standard point-source, point-lens, inertial motion microlensing model. These deviations are crucial in understanding individual lensing systems by breaking the degeneracy between lens mass, position and velocity. We report here on GMAN (Global Microlensing Alert Network), the coordinated follow up of MACHO alerts.