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UNAIDS established fast-track targets of 73% and 86% viral suppression among human immunodeficiency virus (HIV)-positive individuals by 2020 and 2030, respectively. The epidemiologic impact of achieving these goals is unknown. The HIV-Calibrated Dynamic Model, a calibrated agent-based model of HIV transmission, is used to examine scenarios of incremental improvements to the testing and antiretroviral therapy (ART) continuum in South Africa in 2015. The speed of intervention availability is explored, comparing policies for their predicted effects on incidence, prevalence and achievement of fast-track targets in 2020 and 2030. Moderate (30%) improvements in the continuum will not achieve 2020 or 2030 targets and have modest impacts on incidence and prevalence. Improving the continuum by 80% and increasing availability reduces incidence from 2.54 to 0.80 per 100 person-years (−1.73, interquartile range (IQR): −1.42, −2.13) and prevalence from 26.0 to 24.6% (−1.4 percentage points, IQR: −0.88, −1.92) from 2015 to 2030 and achieves fast track targets in 2020 and 2030. Achieving 90-90-90 in South Africa is possible with large improvements to the testing and treatment continuum. The epidemiologic impact of these improvements depends on the balance between survival and transmission benefits of ART with the potential for incidence to remain high.
Adolescence is a sensitive period for sociocultural development in which facets of social identity, including social status and race, become especially salient. Despite the heightened importance of both social status and race during this developmental period, no known work has examined how individual differences in social status influence perceptions of race in adolescents. Thus, in the present study, we investigated how both subjective social status and objective socioeconomic status (SES) influence neural responses to race. Twenty-three Mexican American adolescents (15 females; mean age = 17.22 years) were scanned using functional magnetic resonance imaging while they viewed Black and White faces in a standard labeling task. Adolescents rated their subjective social status in US society, while their parents responded to questions about their educational background, occupation, and economic strain (objective SES). Results demonstrated a negative association between subjective social status and neural responses in the amygdala, fusiform face area, and medial prefrontal cortex when adolescents viewed Black (relative to White) faces. In other words, adolescents with lower subjective social status showed greater activity in neural regions involved in processing salience, perceptual expertise, and thinking about the minds of others when they viewed images of Black faces, suggesting enhanced salience of race for these youth. There was no relationship between objective SES and neural responses to the faces. Moreover, instructing participants to focus on the gender or emotion expression on the face attenuated the relationship between subjective social status and neural processing of race. Together, these results demonstrate that subjective social status shapes the way the brain responds to race, which may have implications for psychopathology.
Traditionally health statistics are derived from civil and/or vital registration. Civil registration in low- to middle-income countries varies from partial coverage to essentially nothing at all. Consequently the state of the art for public health information in low- to middle-income countries is efforts to combine or triangulate data from different sources to produce a more complete picture across both time and space – data amalgamation. Data sources amenable to this approach include sample surveys, sample registration systems, health and demographic surveillance systems, administrative records, census records, health facility records and others. We propose a new statistical framework for gathering health and population data – Hyak – that leverages the benefits of sampling and longitudinal, prospective surveillance to create a cheap, accurate, sustainable monitoring platform. Hyak has three fundamental components:
•Data amalgamation: A sampling and surveillance component that organizes two or more data collection systems to work together: (1) data from HDSS with frequent, intense, linked, prospective follow-up and (2) data from sample surveys conducted in large areas surrounding the Health and Demographic Surveillance System (HDSS) sites using informed sampling so as to capture as many events as possible;
•Cause of death: Verbal autopsy to characterize the distribution of deaths by cause at the population level; and
•Socioeconomic status (SES): Measurement of SES in order to characterize poverty and wealth.
We conduct a simulation study of the informed sampling component of Hyak based on the Agincourt HDSS site in South Africa. Compared with traditional cluster sampling, Hyak's informed sampling captures more deaths, and when combined with an estimation model that includes spatial smoothing, produces estimates of both mortality counts and mortality rates that have lower variance and small bias.
Established methods of recruiting population controls for case–control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case–control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.
In this work, a shorting control (SC) scheme is integrated into a complementary metal-oxide-semiconductor (CMOS) synchronous rectifier for the output voltage regulation of a wireless power supply. The rectifier is designed to operate in a parallel tuned pickup with a 500 mW output power capability for biomedical implants. Without any additional components, the proposed SC method enables the power pickup to operate with high efficiency under variable coupling conditions while maintaining the required load power to keep the output voltage constant. Desired operating conditions are achieved with increased power transfer capability at weak magnetic coupling conditions and higher power efficiency at strong coupling. A novel derivation describes the change in efficiency with SC duty ratio. Experimental validation is completed with an original custom CMOS integrated rectifier with embedded SC. It is demonstrated that the proposed SC method can increase the overall secondary pickup power transfer efficiency by 14% as the magnetic coupling increases to the stronger end.
This study examined the response of forage crops to composted dairy waste (compost) applied at low rates and investigated effects on soil health. The evenness of spreading compost by commercial machinery was also assessed. An experiment was established on a commercial dairy farm with target rates of compost up to 5 t ha−1 applied to a field containing millet [Echinochloa esculenta (A. Braun) H. Scholz] and Pasja leafy turnip (Brassica hybrid). A pot experiment was also conducted to monitor the response of a legume forage crop (vetch; Vicia sativa L.) on three soils with equivalent rates of compost up to 20 t ha−1 with and without ‘additive blends’ comprising gypsum, lime or other soil treatments. Few significant increases in forage biomass were observed with the application of low rates of compost in either the field or pot experiment. In the field experiment, compost had little impact on crop herbage mineral composition, soil chemical attributes or soil fungal and bacterial biomass. However, small but significant increases were observed in gravimetric water content resulting in up to 22.4 mm of additional plant available water calculated in the surface 0.45 m of soil, 2 years after compost was applied in the field at 6 t ha−1 dried (7.2 t ha−1 undried), compared with the nil control. In the pot experiment, where the soil was homogenized and compost incorporated into the soil prior to sowing, there were significant differences in mineral composition in herbage and in soil. A response in biomass yield to compost was only observed on the sandier and lower fertility soil type, and yields only exceeded that of the conventional fertilizer treatment where rates equivalent to 20 t ha−1 were applied. With few yield responses observed, the justification for applying low rates of compost to forage crops and pastures seems uncertain. Our collective experience from the field and the glasshouse suggests that farmers might increase the response to compost by: (i) increasing compost application rates; (ii) applying it prior to sowing a crop; (iii) incorporating the compost into the soil; (iv) applying only to responsive soil types; (v) growing only responsive crops; and (vi) reducing weed burdens in crops following application. Commercial machinery incorporating a centrifugal twin disc mechanism was shown to deliver double the quantity of compost in the area immediately behind the spreader compared with the edges of the spreading swathe. Spatial variability in the delivery of compost could be reduced but not eliminated by increased overlapping, but this might represent a potential 20% increase in spreading costs.
The objective of the present study was to investigate live weight (LW) gain, urinary nitrogen (UN) excretion and urination behaviour of dairy heifers grazing pasture, chicory and plantain in autumn and spring. The study comprised a 35-day autumn trial (with a 7-day acclimation period) and a 28-days spring trial (with a 7-day acclimation period). For each trial, 56 Friesian × Jersey heifers were blocked into five dietary treatments balanced for their LW and breeding worth (i.e. genetic merit of a cow for production and reproduction): 1·00 perennial ryegrass–white clover pasture (PA); 1·00 chicory (CH); 1·00 plantain (PL); 0·50 pasture + 0·50 chicory (PA + CH); and 0·50 pasture + 0·50 plantain (PA + PL). A fresh allocation of the herbage was offered every 3 days with allowance calculated according to feed requirement for maintenance plus gain of 1·0 kg LW/day. In both trials, LW gain was lower on CH than other treatments. In the spring trial, UN concentration and UN excretion were lower in CH and PL than other treatments. In autumn, a higher urination frequency was observed over the first 6 h after forage allocation in CH and PA + CH than other treatments. Data from the present study indicate that feeding CH alone limited heifer LW gain. However, heifers grazing swards containing chicory (CH and PA + CH) and plantain (PL and PA + PL) had the potential to lower nitrous oxide emissions and nitrate leaching from soil compared with heifers grazing PA, by reducing N loading in urine patches.
Alkaptonuria is an inborn error of metabolism. It is a multisystem disease with characteristic ENT manifestations. This paper reports, for the first time, the ENT findings in a cohort of alkaptonuria patients.
Patients attending the National Centre for Alkaptonuria (Royal Liverpool and Broadgreen University Hospitals NHS Trust) underwent a full ENT assessment.
Eighteen of the 20 patients (90 per cent) had an ENT sign or symptom. These included discolouration of the pinna, cerumen, nasal septum and pharynx.
Discolouration of cerumen may occur before 30 years of age and may therefore be an important early clinical sign. Further audiological assessment of patients is needed to clarify if an association exists between alkaptonuria and hearing loss. Alkaptonuria is a condition that could present to the otolaryngologist. Successful early diagnosis and referral to a specialist centre is essential so that patients can be offered disease-modifying therapy.
This study aimed to estimate the prevalence and risk factors for hepatitis C virus (HCV) infection in Mexican Americans living in South Texas. We tested plasma for the presence of HCV antibody from the Cameron County Hispanic Cohort (CCHC), a randomized, population-based cohort in an economically disadvantaged Mexican American community on the United States/Mexico border with high rates of chronic disease. A weighted prevalence of HCV antibody of 2·3% [n = 1131, 95% confidence interval (CI) 1·2–3·4] was found. Participants with diabetes had low rates of HCV antibody (0·4%, 95% CI 0·0–0·9) and logistic regression revealed a statistically significant negative association between HCV and diabetes (OR 0·20, 95% CI 0·05–0·77) after adjusting for sociodemographic and clinical factors. This conflicts with reported positive associations of diabetes and HCV infection. No classic risk factors were identified, but important differences between genders emerged in analysis. This population-based study of HCV in Mexican Americans suggests that national studies do not adequately describe the epidemiology of HCV in this border community and that unique risk factors may be involved.
Mindfulness-based cognitive therapy (MBCT) is a group-based intervention similar to mindfulness-based stress reduction, but which includes cognitive therapy techniques. This study investigates its usefulness in the treatment of depressive, anxiety and stress/distress symptoms in cancer patients referred to a psycho-oncology service. It also examines whether effect on depression is mediated by self-compassion.
In phase 1 of this study, 16 cancer patients with mild/moderate psychological distress were randomised to MBCT (n=8) or treatment as usual (TAU; n=8), and assessed pre- and post-treatment. Analysis of variance was performed to examine the effect of treatment on anxiety and depression. In phase 2, the TAU group received the intervention, and results of pre- and post-MBCT assessments were combined with those receiving MBCT in phase 1. Finally, both groups were followed up at 3 months.
In phase 1, the MBCT group had a significant improvement in mindfulness and a decrease in anxiety. Statistically significant improvements in both depression and anxiety were found at 3 month follow-up. Self-compassion appeared to mediate the effect on anxiety/depression.
This small pilot study suggests that MBCT may have a beneficial effect on psychological variables often adversely affected in cancer in a heterogeneous cancer population.
This article discusses the benefits and challenges of offering an onsite seminar on Canadian politics and foreign policy and assesses how this format contributes to achieving the goals of the 2011 APSA report, Teaching Political Science in the 21st Century. First, the author describes the development and requirements of the College of Liberal Arts and Sciences Global Seminar series at Iowa State University, the structure of the seminar, and its operation in Ottawa. Second, several of the pedagogical and experiential benefits, as well as the challenges, for making the seminar successful are identified and discussed. Third, by weighing these benefits and challenges, the author concludes that such a seminar has the potential to serve as an effective model for increasing an understanding of Canadian politics among American students, as well as to meet several important recommendations for improving the teaching of political science today.
We examined the intention to comply with mandatory hurricane evacuation orders among respondents living in coastal areas with pronounced poverty by demographic and location characteristics.
A 3-county door-to-door survey was conducted with 1 randomly selected resident per household. Households were selected using a 2-stage cluster sampling strategy and stratified by county. The final sample included 3088 households in 100 census tracts across 3 counties.
Findings suggest that the majority of residents living in areas prone to hurricanes intend to comply with mandatory evacuation orders regardless of income level. Variation in intention to comply with mandatory evacuation orders is shown by age, gender, ethnicity, education, acculturation, county, and distance from shoreline.
The demonstrated high intention to comply with evacuation orders in impoverished areas suggests a need for improved planning to evacuate the most vulnerable residents. Demographic and location characteristics associated with decreased intention to comply may be considered for targeting messages and education before disasters to modifying intentions and plans to evacuate. (Disaster Med Public Health Preparedness. 2013;7:46-54)
Transmission of hepatitis C (HCV) in Pakistan is a continuing public health problem; 15 years ago it was linked to the practice of reusing therapeutic instruments in healthcare settings. We sought to examine current risk factors for HCV transmission in a hospital population in Karachi, Pakistan. We enrolled 300 laboratory-confirmed HCV-positive participants and 300 laboratory-confirmed HCV-negative participants from clinics at Indus Hospital. Independent and significant risk factors for both men and women were: receiving ⩾12 injections in the past year, blood transfusions, having had dental work performed, and delivery in hospital or transfusion for women. Interestingly, being of Mohajir origin or born in Sindh province were protective. Encouragingly, a strong protective effect was observed for those that reported bringing their own needle for injections (59%). The widespread reuse of therapeutic needles in healthcare settings in Karachi remains a major driver of the HCV epidemic.
This study aims to assess current practices of Canadian physicians providing botulinum toxin-A (BoNT-A) treatments for children with hypertonia and to contrast these with international “best practice” recommendations, in order to identify practice variability and opportunities for knowledge translation.
Thirteen Canadian physicians assembled to develop and analyze results of a cross-sectional electronic survey, sent to 50 physicians across Canada.
Seventy-eight percent (39/50) of physicians completed the survey. The most frequently identified assessment tools were Gross Motor Function Classification System, Modified Tardieu Scale and neurological examination. Goal-setting tools were infrequently utilized. Common indications for BoNT-A injections and the muscles injected were identified. Significant variability was identified in using BoNT-A for hip displacement associated with hypertonia. The most frequent adverse event reported was localized weakness; 54% reporting this “occasionally“ and 15% “frequently”. Generalized weakness, fatigue, ptosis, diplopia, dysphagia, aspiration, respiratory distress, dysphonia and urinary incontinence were reported rarely or never. For dosage, 52% identified 16 Units/kg body weight of Botox® as maximum. A majority (64%) reported a maximum 400 Units for injection at one time. For localization, electrical stimulation and ultrasound were used infrequently (38% and 19% respectively). Distraction was the most frequently used pain-management technique (64%).
Canadian physicians generally adhere to international best practices when using BoNT-A to treat paediatric hypertonia. Two knowledge-translation opportunities were identified: use of individualized goal setting prior to BoNT-A and enhancing localization techniques. Physicians reported a good safety profile of BoNT-A in children.