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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.
To profile discretionary food and beverage (DF) consumption among Australian adults.
Cross-sectional analysis. Dietary and sociodemographic data were used to profile DF intake. Prevalence of DF consumption, DF servings (1 serving=600 kJ), nutrient contribution from DF and top DF food groups by self-reported eating occasions were determined. DF consumers (>0 g) were classified according to quartile of DF intake and general linear models adjusted for age and sex were used to determine associations.
2011–12 National Nutrition and Physical Activity Survey (NNPAS).
Adults aged ≥19 years (n 9341) who participated in the NNPAS 2011–12.
Most adults consumed DF (98 %) and over 60 % exceeded 3 DF servings/d, with a mean of 5·0 (se 0·0) DF servings/d. Cakes, muffins, scones, cake-type desserts contributed the most DF energy (8·4 %) of all food groups, followed by wines (8·1 %), pastries (8·0 %) and beers (6·1 %), with all these food groups consumed in large portions (2·3–3·0 DF servings). Lunch and dinner together contributed 45 % of total DF energy intake. High DF consumers had an average of 10 DF servings, and this group contained more younger adults, males, low socio-economic status, lower usual fruit intake and higher mean waist circumference, but not higher BMI.
A focus on DF consumed in large portions at lunch and dinner may help improve interventions aimed at reducing DF intake and addressing negative adiposity-related measures found in high DF consumers.
Tumor necrosis factor alpha-induced protein 3 (TNFAIP3) is a multifunctional ubiquitin binding and editing enzyme that regulates inflammation. Genetic studies have implicated polymorphisms within the TNFAIP3 locus to the development of numerous immune-related diseases. This study evaluated the frequencies of single-nucleotide polymorphism (SNPs) within the exonic regions of the TNFAIP3 gene and an associated point mutation from the Illumina array among a predominantly Hispanic cohort.
Genomic DNA was obtained from 721 participants and sequencing of all TNFAIP3 exons and an intergenic point mutation (rs6920220) was performed. In-vitro functional assessment was performed by transfecting mutated TNFAIP3 constructs into TNFAIP3 knockout cells containing the NF-kB luciferase reporter and stimulating with TNFα. Comparative statistics were performed with Student’s t-test for continuous variables and chi-squared test for categorical variables.
Sequencing revealed two missense SNPs, rs146534657:A>G and rs2230926:T>G, both within exon 3 of TNFAIP3, which encodes the protein’s deubiquitinating enzymatic domain. Frequencies of all three point mutations differed significantly across racial groups (χ2-test, P = 0.014 to P < 0.001). Compared to Caucasians, rs146534657:A>G was overrepresented among Hispanics (odds ratio (OR) [95% CI] 4.05 [1.24−13.18]), and rs2230926:T>G was more prevalent among African-Americans (OR [95% CI] 3.65 [1.58−8.43]). In-vitro assays confirm rs146534657:A>G and rs2230926:T>G decrease the ability of TNFAIP3 to abrogate NF-κB activation by 2-fold (P < 0.01) and 1.7-fold (P < 0.01), respectively.
This study reports the frequency of rs146534657:A>G among Hispanics and is the first to evaluate its potential physiologic impact, establishing a basis for future research as a potential biomarker among this population.
Although school-based programmes for the identification of children and young people (CYP) with mental health difficulties (MHD) have the potential to improve short- and long-term outcomes across a range of mental disorders, the evidence-base on the effectiveness of these programmes is underdeveloped. In this systematic review, we sought to identify and synthesise evidence on the effectiveness and cost-effectiveness of school-based methods to identify students experiencing MHD, as measured by accurate identification, referral rates, and service uptake.
Electronic bibliographic databases: MEDLINE, Embase, PsycINFO, ERIC, British Education Index and ASSIA were searched. Comparative studies were included if they assessed the effectiveness or cost-effectiveness of strategies to identify students in formal education aged 3–18 years with MHD, presenting symptoms of mental ill health, or exposed to psychosocial risks that increase the likelihood of developing a MHD.
We identified 27 studies describing 44 unique identification programmes. Only one study was a randomised controlled trial. Most studies evaluated the utility of universal screening programmes; where comparison of identification rates was made, the comparator test varied across studies. The heterogeneity of studies, the absence of randomised studies and poor outcome reporting make for a weak evidence-base that only generate tentative conclusions about the effectiveness of school-based identification programmes.
Well-designed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models, as well as their effectiveness in connecting students to appropriate support in real-world settings.
As multi-core computing is now standard, it seems irresponsible for constraints researchers to ignore the implications of it. Researchers need to address a number of issues to exploit parallelism, such as: investigating which constraint algorithms are amenable to parallelisation; whether to use shared memory or distributed computation; whether to use static or dynamic decomposition; and how to best exploit portfolios and cooperating search. We review the literature, and see that we can sometimes do quite well, some of the time, on some instances, but we are far from a general solution. Yet there seems to be little overall guidance that can be given on how best to exploit multi-core computers to speed up constraint solving. We hope at least that this survey will provide useful pointers to future researchers wishing to correct this situation.
Mechanical properties of neurons represent a key factor that determines the functionality of neuronal cells and the formation of neural networks. The main source of mechanical stability for the cell is a biopolymer network of microtubules and actin filaments that form the main components of the cellular cytoskeleton. This biopolymer network is responsible for the growth of neuronal cells as they extend neurites to connect with other neurons, forming the nervous system. Here we present experimental results that combine atomic force microscopy (AFM) and fluorescence microscopy to produce systematic, high-resolution elasticity and fluorescence maps of cortical neurons. This approach allows us to apply external forces to neurons, and to monitor the dynamics of the cell cytoskeleton. We measure how the elastic modulus of neurons changes upon changing the ambient temperature, and identify the cytoskeletal components responsible for these changes. These results demonstrate the importance of taking into account the effect of ambient temperature when measuring the mechanical properties of cells.
Presenting new approaches to studying food webs, this book uses practical management and policy examples to demonstrate the theory behind ecosystem management decisions and the broader issue of sustainability. All the information that readers need to use food web analyses as a tool for understanding and quantifying transition processes is provided. Advancing the idea of food webs as complex adaptive systems, readers are challenged to rethink how changes in environmental conditions affect these systems. Beginning with the current state of thinking about community organisation, complexity and stability, the book moves on to focus on the traits of organisms, the adaptive nature of communities and their impacts on ecosystem function. The final section of the book addresses the applications to management and sustainability. By helping to understand the complexities of multispecies networks, this book provides insights into the evolution of organisms and the fate of ecosystems in a changing world.
Where polythermal glaciers have frozen margins that buttress otherwise temperate-based sliding ice, longitudinal compression can strongly influence ice-flow trajectory, and consequently sediment transport paths. Past efforts to model flow in the vicinity of a basal thermal transition (BTT) have generally relied on simplified boundary conditions or rheological idealizations, making these model results difficult to apply to real glacier termini. Herein, we present results of numerical simulations using a power-law rheology and with boundary conditions that better represent the frozen margin. Model results indicate that a transition to a non-sliding frozen margin causes a decline in surface velocity made possible by upward ice flow, implying either enhanced ablation for steady-state simulations or the formation of a surface bulge. Permitting ice loss by ablation combined with numerical smoothing of the basal slip transition subdues basal stress concentrations and thereby inhibits development of structural discontinuities such as thrust faults. Upward ice flow is accommodated by vertical extension up-glacier of the BTT. This strain regime can potentially account for key structural features in polythermal glacier termini without appealing to thrusting.
A simple circuit has been developed to allow measurement of brief subglacial water-pressure pulses. This circuit continuously powers a pressure transducer and captures the peak output of the transducer during each measurement interval, thus allowing determination of the maximum pressure attained during the interval. This circuit provides an alternative to setting a data logger to perform rapid repeated measurements, and overcomes some key limitations imposed by rapid measurement. Benefits include significantly lower demands on the data-logger microprocessor, which allows additional instruments to be monitored simultaneously, reduced memory usage and moderately lower power consumption. The reduced microprocessor and memory loads allow older and slower logger models, many of which are still in common use, to be used to obtain data that compare favourably with high-frequency data obtained using newer data loggers.
The cold-based termini of polythermal glaciers are usually assumed to adhere strongly to an immobile substrate and thereby supply significant resistance to the flow of warm-based ice up-glacier. This compressive environment is commonly thought to uplift basal sediment to the surface of the glacier by folding and thrust faulting. We present model and field evidence from the terminus of Storglaciären, Sweden, showing that the cold margin provides limited resistance to flow from up-glacier. Ice temperatures indicate that basal freezing occurs in this zone at 10−1 −10−2 m a−1, but model results indicate that basal motion at rates greater than 1 m a−1 must, nevertheless, persist there for surface and basal velocities to be consistent with measurements. Estimated longitudinal compressive stresses of 20–25 kPa within the terminus further indicate that basal resistance offered by the cold-based terminus is small. These results indicate that where polythermal glaciers are underlain by unlithified sediments, ice-flow trajectories and sediment transport pathways may be affected by subglacial topography and hydrology more than by the basal thermal regime.