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OBJECTIVES/GOALS: To determine the prevalence of myocardial diastolic dysfunction (DD) and association of serum concentration of the cardiac biomarker serum soluble ST2 in HIV-infected as compared to uninfected Tanzanian adults at the time of HIV diagnosis. METHODS/STUDY POPULATION: In this cross-sectional study we consecutively enrolled HIV-infected participants and uninfected controls at a large, referral HIV clinic in Mwanza, Tanzania. Standardized history, physical examination, echocardiography and serum samples were obtained. The primary outcome was prevalence of myocardial diastolic dysfunction in HIV-infected as compared to uninfected adults. The secondary outcome was the association of baseline serum sST2 concentration with diastolic dysfunction prevalence. Regression models were used to quantify the associations. RESULTS/ANTICIPATED RESULTS: We enrolled 388 HIV-infected, ART naïve and 461 HIV-uninfected controls. Participants with HIV had a higher prevalence of DD (OR = 2.44, p = 0.001, controlled for age, sex, hypertension and BMI) and more severe dysfunction (66.7% vs 42.5%, p = 0.056) at an earlier age. Baseline serum sST2 concentration was significantly associated with DD in HIV-infected but not uninfected participants (p = 0.04 and 0.90, respectively). More HIV-infected adults with concurrent DD exceeded the threshold of 35ng/mL as compared to controls (15.7% vs 5.3%, p<0.0001). Additionally, a significant population level shift to higher sST2 concentration was observed in HIV-infected adults with dysfunction as compared to both HIV-infected without and HIV-uninfected adults with dysfunction (Kolmogrov-Smirnov test: p = 0.02 and 0.04). DISCUSSION/SIGNIFICANCE OF IMPACT: In a large population of HIV-infected adults in sub-Saharan Africa, HIV infection is associated with myocardial diastolic dysfunction. This dysfunction is associated with higher sST2 concentrations. Therefore, we conclude that the sST2 pathway may provide insight into the pathophysiologic mechanisms of dysfunction in HIV-infected adults.
Donjek Glacier has an unusually short and regular surge cycle, with eight surges identified since 1935 from aerial photographs and satellite imagery with a ~12 year repeat interval and ~2 year active phase. Recent surges occurred during a period of long-term negative mass balance and cumulative terminus retreat of 2.5 km since 1874. In contrast to previous work, we find that the constriction where the valley narrows and bedrock lithology changes, 21 km from the terminus, represents the upper limit of surging, with negligible surface speed or elevation change up-glacier from this location. This positions the entire surge-type portion of the glacier in the ablation zone. The constriction geometry does not act as the dynamic balance line, which we consistently find at 8 km from the glacier terminus. During the 2012–2014 surge event, the average lowering rate in the lowest 21 km of the glacier was 9.6 m a−1, while during quiescence it was 1.0 m a−1. Due to reservoir zone refilling, the ablation zone has a positive geodetic balance in years immediately following a surge event. An active surge phase can result in a strongly negative geodetic mass balance over the surge-type portion of the glacier.
Astrophysics Telescope for Large Area Spectroscopy Probe is a concept for a National Aeronautics and Space Administration probe-class space mission that will achieve ground-breaking science in the fields of galaxy evolution, cosmology, Milky Way, and the Solar System. It is the follow-up space mission to Wide Field Infrared Survey Telescope (WFIRST), boosting its scientific return by obtaining deep 1–4 μm slit spectroscopy for ∼70% of all galaxies imaged by the ∼2 000 deg2 WFIRST High Latitude Survey at z > 0.5. Astrophysics Telescope for Large Area Spectroscopy will measure accurate and precise redshifts for ∼200 M galaxies out to z < 7, and deliver spectra that enable a wide range of diagnostic studies of the physical properties of galaxies over most of cosmic history. Astrophysics Telescope for Large Area Spectroscopy Probe and WFIRST together will produce a 3D map of the Universe over 2 000 deg2, the definitive data sets for studying galaxy evolution, probing dark matter, dark energy and modifications of General Relativity, and quantifying the 3D structure and stellar content of the Milky Way. Astrophysics Telescope for Large Area Spectroscopy Probe science spans four broad categories: (1) Revolutionising galaxy evolution studies by tracing the relation between galaxies and dark matter from galaxy groups to cosmic voids and filaments, from the epoch of reionisation through the peak era of galaxy assembly; (2) Opening a new window into the dark Universe by weighing the dark matter filaments using 3D weak lensing with spectroscopic redshifts, and obtaining definitive measurements of dark energy and modification of General Relativity using galaxy clustering; (3) Probing the Milky Way’s dust-enshrouded regions, reaching the far side of our Galaxy; and (4) Exploring the formation history of the outer Solar System by characterising Kuiper Belt Objects. Astrophysics Telescope for Large Area Spectroscopy Probe is a 1.5 m telescope with a field of view of 0.4 deg2, and uses digital micro-mirror devices as slit selectors. It has a spectroscopic resolution of R = 1 000, and a wavelength range of 1–4 μm. The lack of slit spectroscopy from space over a wide field of view is the obvious gap in current and planned future space missions; Astrophysics Telescope for Large Area Spectroscopy fills this big gap with an unprecedented spectroscopic capability based on digital micro-mirror devices (with an estimated spectroscopic multiplex factor greater than 5 000). Astrophysics Telescope for Large Area Spectroscopy is designed to fit within the National Aeronautics and Space Administration probe-class space mission cost envelope; it has a single instrument, a telescope aperture that allows for a lighter launch vehicle, and mature technology (we have identified a path for digital micro-mirror devices to reach Technology Readiness Level 6 within 2 yr). Astrophysics Telescope for Large Area Spectroscopy Probe will lead to transformative science over the entire range of astrophysics: from galaxy evolution to the dark Universe, from Solar System objects to the dusty regions of the Milky Way.
A new deep level transient spectroscopy (DLTS) technique is described, called half-width at variable intensity analysis. This method utilizes the width and normalized intensity of a DLTS signal to determine the activation energy and capture cross section of the trap that generated the signal via a variable, kO. This constant relates the carrier emission rates giving rise to the differential capacitance signal associated with a given trap at two different temperatures: the temperature at which the maximum differential capacitance is detected, and an arbitrary temperature at which some nonzero differential capacitance signal is detected. The extracted activation energy of the detected trap center is used along with the position of the peak maximum to extract the capture cross section of the trap center.
The realization of an electrically driven organic solid-state laser is an ambitious but highly desirable goal. Many obstacles need to be solved before a working device can be realized. One of the most challenging tasks is an incorporation of intracavity metal contacts, which, on the one hand, would not substantially degrade optical properties of the whole device and, on the other hand, would ensure sufficient current density to reach lasing. In this paper, we present different contact compositions aiming to realize high-quality intracavity metal contacts. We build a top contact consisting of 0.5 nm of aluminum and 4 nm of silver which has a conductivity of 1.9 × 107 (Ω/m) and is not increasing the optical lasing threshold of an organic microcavity. To get a better understanding of charge carriers influencing the device performance, we have performed a set of measurements, where a hybrid OLED–MC device was excited both optically and electrically at the same time. These experiments suggest that the charge carriers do not degrade electrical performance, at least for current densities in the range of A/cm2. Moreover, our observations suggest that, in some cases, simultaneous optical excitation can contribute to more efficient electrical pumping of the OLED-MC device.
Climate Change Adaptation Strategies and Sustainability of Philippine Agriculture
Majah-Leah V. Ravago, Research Faculty at the Department of Economics, Ateneo de Manila University, and previously Assistant Professor at the School of Economics, University of the Philippines, Diliman.,
James A. Roumasset, Professor (emeritus) at the Department of Economics, University of Hawaii, USA.,
Karl Robert L. Jandoc, Assistant Professor at the School of Economics, University of the Philippines, Diliman.
The Philippines is inherently vulnerable to adverse natural events of extreme intensity purely based on its geographic location.1 The warm western Pacific waters, normally around 28°C, contribute to the formation of typhoons, 18–20 of which reach the Philippines each year on average. Cagayan Valley (Region 2), Central Luzon (Region 3), and the Cordillera Administrative Region (CAR) are particularly vulnerable, averaging about seven to nine typhoons per year (Figure 8.1). Flooding occurs in a number of regions, the Western Visayas registering the highest incidence. The Philippines also rests on the Pacific “Ring of Fire”, where most of the earth's volcanic eruptions and earthquakes occur. Geophysical events, such as earthquakes and tsunamis, occur with regularity, albeit at long intervals. The Bicol Region, home of the active Mayon Volcano, experienced the greatest number of volcanic eruptions during 1991–2006. Earthquakes of moderate and high magnitude occur most frequently in the Central Visayas and Bicol regions (Figure 8.1).
Climate projections for the Philippines are similar to those in many other parts of the world (Chapters 2 and 4, this volume). Using the Intergovernmental Panel on Climate Change (IPCC) for the “A1B scenario” most relevant to the Philippines, Cinco et al. (2013) projected that mean yearly temperatures will rise between 1.9°C and 2.2°C by 2050, over baseline levels of between 25.5°C and 27.6°C (derived as averages of minimum and maximum temperatures for the 1971–2000 period). Increasing rainfall concentration and mean rainfall levels indicate that the wet seasons of June–August and September–November will become wetter in Luzon and Visayas towards 2050, yet higher rainfall concentrations combined with higher temperatures are likely to increase moisture stress in the dry season. In particular, it is expected that the frequency of damaging storms will increase. Although disputed by some (Cruz et al. 2007), evidence also suggests that the frequency of droughts will increase (Miyan 2015). One implication of these changes is that farmers’ experience of the frequency, duration, strength, and timing of rainfall and the frequency of droughts will be less reliable than previously; hence, the accuracy of their subjective decision-making processes will decline, causing their level of risk to rise. Past experience will become — and is already becoming — less useful as a predictor of future experience. The bottom line is that risk and uncertainty facing farmers are increasing.
This chapter deals with promoting the common good through better energy, resource and environmental policies as well as improved management of natural disaster risks, including climate change. Increasing gross domestic product (GDP) will be insufficient to meet the aspirations of the Philippine people for higher levels of living, inasmuch as GDP does not measure welfare. Largely because of the omission of these elements, we begin with a discussion of green accounting — the method of extending national income accounting to include the degradation of the environment and the depletion of natural resources.
As we discuss in the second part, comprehensive national income accounting can be further extended to include natural disasters and other shocks to the ecological–economic system. Even policy distortions can be accounted for by including them as constraints to the system. Thus, environmental resource conservation, disaster preparedness and policy reform all become potential sources of welfare growth. The later section deals with the mission of sustainable development, particularly how the Sustainable Development Goals (SDGs) relate to the mission of improving the welfare of Filipinos.
Increasing Levels of Living in the Face of Environmental Degradation and Resource Depletion
Stewardship of natural resources and the environment should not be treated as a separate objective from management of the economy (World Commission on Environment and Development 1987). The fundamental premise of sustainable income and green accounting, which have a long history in the Philippines and other countries, is that nature and the economy are part of the same system (the environomy) as shown in Figure 6.1. And one system requires one unifying measure of performance.
To convert the most common indicator of the size of an economy, GDP, into a measure of national well-being, several adjustments must be made. It is well known that GDP overestimates public welfare by failing to deduct depreciation — that portion of investment that simply replaces capital which has worn out or become obsolete. Deducting capital depreciation from GDP yields net domestic product (NDP). And since income is a better measure of welfare than production, we need to subtract the income earned in the Philippines by foreigners, add income earned by Philippine citizens abroad, and add remittances to the Philippines by non-citizens.
Population-based registries report 95% 5-year survival for children undergoing surgery for CHD. This study investigated paediatric cardiac surgical outcomes in the Australian indigenous population.
All children who underwent cardiac surgery between May, 2008 and August, 2014 were studied. Demographic information including socio-economic status, diagnoses and co-morbidities, and treatment and outcome data were collected at time of surgery and at last follow-up.
A total of 1528 children with a mean age 3.4±4.6 years were studied. Among them, 123 (8.1%) children were identified as indigenous, and 52.7% (62) of indigenous patients were in the lowest third of the socio-economic index compared with 28.2% (456) of non-indigenous patients (p⩽0.001). The indigenous sample had a significantly higher Comprehensive Aristotle Complexity score (indigenous 9.4±4.2 versus non-indigenous 8.7±3.9, p=0.04). The probability of having long-term follow-up did not differ between groups (indigenous 93.8% versus non-indigenous 95.6%, p=0.17). No difference was noted in 30-day mortality (indigenous 3.2% versus non-indigenous 1.4%, p=0.13). The 6-year survival for the entire cohort was 95.9%. The Cox survival analysis demonstrated higher 6-year mortality in the indigenous group – indigenous 8.1% versus non-indigenous 5.0%; hazard ratio (HR)=2.1; 95% confidence intervals (CI): 1.1, 4.2; p=0.03. Freedom from surgical re-intervention was 79%, and was not significantly associated with the indigenous status (HR=1.4; 95% CI: 0.9, 1.9; p=0.11). When long-term survival was adjusted for the Comprehensive Aristotle Complexity score, no difference in outcomes between the populations was demonstrated (HR=1.6; 95% CI: 0.8, 3.2; p=0.19).
The indigenous population experienced higher late mortality. This apparent relationship is explained by increased patient complexity, which may reflect negative social and environmental factors.
Imaging biomarkers for Alzheimer's disease include medial temporal lobe
atrophy (MTLA) depicted on computed tomography (CT) or magnetic resonance
imaging (MRI) and patterns of reduced metabolism on fluorodeoxyglucose
positron emission tomography (FDG-PET).
To investigate whether MTLA on head CT predicts the diagnostic usefulness
of an additional FDG-PET scan.
Participants had a clinical diagnosis of Alzheimer's disease
(n = 37) or dementia with Lewy bodies (DLB;
n = 30) or were similarly aged controls
(n = 30). We visually rated MTLA on coronally
reconstructed CT scans and, separately and blind to CT ratings, abnormal
appearances on FDG-PET scans.
Using a pre-defined cut-off of MTLA ⩾5 on the Scheltens (0–8) scale, 0/30
controls, 6/30 DLB and 23/30 Alzheimer's disease had marked MTLA. FDG-PET
performed well for diagnosing Alzheimer's disease v. DLB
in the low-MTLA group (sensitivity/specificity of 71%/79%), but in the
high-MTLA group diagnostic performance of FDG-PET was not better than
In the presence of a high degree of MTLA, the most likely diagnosis is
Alzheimer's disease, and an FDG-PET scan will probably not provide
significant diagnostic information. However, in cases without MTLA, if
the diagnosis is unclear, an FDG-PET scan may provide additional
clinically useful diagnostic information.
Determining which patients with ureterolithiasis are likely to require urologic intervention is a common challenge in the emergency department (ED). The objective was to determine if normal renal sonogram could identify low-risk renal colic patients, who were defined as not requiring urologic intervention within 90 days of their initial ED visit and can be managed conservatively.
This was a prospective cohort study involving adult patients presenting to the EDs of a tertiary care centre with suspected renal colic over a 20-month period. Renal ultrasonography (US) was performed in the diagnostic imaging department by trained ultrasonographers, and the results were categorized into four mutually exclusive groups: normal, suggestive of ureterolithiasis, visualized ureteric stone, or findings unrelated to urolithiasis. Electronic medical records were reviewed to determine if patients received urologic intervention within 90 days of their ED visit.
Of 610 patients enrolled, 341 (55.9%) had US for suspected renal colic. Of those, 105 (30.8%) were classified as normal; none of these patients underwent urologic intervention within 90 days of their ED visit. Ninety (26.4%) US results were classified as suggestive, and nine (10%) patients received urologic intervention. A total of 139 (40.8%) US results were classified as visualized ureteric stone, and 34 (24.5%) patients had urologic intervention. Seven (2.1%) US results were classified as findings unrelated to urolithiasis, and none of these patients required urologic intervention. The rate of urologic intervention was significantly lower in those with normal US results (p<0.001) than in those with abnormal findings.
A normal renal sonogram predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected renal colic.