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Food insecurity, or self-reports of inadequate food access due to limited financial resources, remains prevalent among people living with HIV (PLHIV). We examined the impact of food insecurity on combination antiretroviral therapy (cART) adherence within an integrated care programme that provides services to PLHIV, including two meals per day.
Adjusted OR (aOR) were estimated by generalized estimating equations, quantifying the relationship between food insecurity (exposure) and cART adherence (outcome) with multivariable logistic regression.
We drew on survey data collected between February 2014 and March 2016 from the Dr. Peter Centre Study based in Vancouver, Canada.
The study included 116 PLHIV at baseline, with ninety-nine participants completing a 12-month follow-up interview. The median (quartile 1–quartile 3) age was 46 (39–52) years at baseline and 87 % (n 101) were biologically male at birth.
At baseline, 74 % (n 86) of participants were food insecure (≥2 affirmative responses on Health Canada’s Household Food Security Survey Module) and 67 % (n 78) were adherent to cART ≥95 % of the time. In the adjusted regression analysis, food insecurity was associated with suboptimal cART adherence (aOR = 0·47, 95 % CI 0·24, 0·93).
While food provision may reduce some health-related harms, there remains a relationship between this prevalent experience and suboptimal cART adherence in this integrated care programme. Future studies that elucidate strategies to mitigate food insecurity and its effects on cART adherence among PLHIV in this setting and in other similar environments are necessary.
Precise radiocarbon (14C) dating of sedimentary sequences is important for developing robust chronologies of environmental change, but sampling of suitable components can be challenging in highly dynamic landscapes. Here we investigate radiocarbon determinations of different peat size fractions from six peat sites, representing a range of geomorphological contexts on the South Atlantic subantarctic islands of the Falklands and South Georgia. To investigate the most suitable fraction for dating, 112 measurements were obtained from three components within selected horizons: a fine fraction <0.2 mm, a coarse fraction >0.2 mm, and bulk material. We find site selection is critical, with locations surrounded by high-ground and/or relatively slowly accumulating sites more susceptible to the translocation of older carbon. Importantly, in locations with reduced potential for redeposition of material, our results show that there is no significant or systematic difference between ages derived from bulk material, fine or coarse (plant macrofossil) material, providing confidence in the resulting age model. Crucially, in areas comprising complex terrain with extreme relief, we recommend dating macrofossils or bulk carbon rather than a fine fraction, or employing comprehensive dating of multiple sedimentary fractions to determine the most reliable fraction(s) for developing a robust chronological framework.
This research investigates two factors influencing the ability of tree-ring data to provide accurate 14C calibration information: the fitness and rigor of the statistical model used to combine the data into a curve; and the accuracy, precision and reproducibility of the component 14C data sets. It presents a new Bayesian spline method for calibration curve construction and tests it on extant and new Southern Hemisphere (SH) data sets (also examining their dendrochronology and pretreatment) for the post-Little Ice Age (LIA) interval AD 1500–1950. The new method of construction allows calculation of component data offsets, permitting identification of laboratory and geographic biases. Application of the new method to the 10 suitable SH 14C data sets suggests that individual offset ranges for component data sets appear to be in the region of ± 10 yr. Data sets with individual offsets larger than this need to be carefully assessed before selection for calibration purposes. We identify a potential geographical offset associated with the Southern Ocean (high latitude) Campbell Island data. We test the new methodology for wiggle-matching short tree-ring sequences and use an OxCal simulation to assess the likely precision obtainable by wiggle-matching in the post-LIA interval.
Simulation-based training has a fundamental role in medical education as it allows the learner to gain experience managing emergencies in a safe, controlled environment.
This 1-day course consisted of eight high-fidelity simulation scenarios, followed by a video-assisted debrief focusing on the technical and non-technical (communication skills, teamwork, leadership and situational awareness) aspects of managing ENT and head and neck emergencies.
Eight courses have run since June 2014. Post-course questionnaires demonstrated that candidates’ confidence scores in managing airway and head and neck emergencies increased following completion of the course (p < 0.0001).
This was the first fully immersive ENT simulation course developed in the region. The learning objectives for each scenario were mapped to the ENT Intercollegiate Surgical Curriculum Programme. Feedback from the course indicated a continued demand for this style of training, leading to its inclusion in the training calendar.
Recent studies have improved our understanding of nearshore marine ecosystems surrounding Ascension Island (central Atlantic Ocean), but little is known about Ascension's benthic environment beyond its shallow coastal waters. Here, we report the first detailed physical and biological examination of the seabed surrounding Ascension Island at 100–1000 m depth. Multibeam swath data were used to map fine scale bathymetry and derive seabed slope and rugosity indices for the entire area. Water temperature and salinity profiles were obtained from five Conductivity, Temperature, Depth (CTD) deployments, revealing a spatially consistent thermocline at 80 m depth. A camera lander (Shelf Underwater Camera System; SUCS) provided nearly 400 images from 21 sites (100 m transects) at depths of 110–1020 m, showing high variability in the structure of benthic habitats and biological communities. These surveys revealed a total of 95 faunal morphotypes (mean richness >14 per site), complemented by 213 voucher specimens constituting 60 morphotypes collected from seven targeted Agassiz trawl (AGT) deployments. While total faunal density (maximum >300 m−2 at 480 m depth) increased with rugosity, characteristic shifts in multivariate assemblage structure were driven by depth and substratum type. Shallow assemblages (~100 m) were dominated by black coral (Antipatharia sp.) on rocky substrata, cup corals (Caryophyllia sp.) and sea urchins (Cidaris sp.) were abundant on fine sediment at intermediate depths (250–500 m), and shrimps (Nematocarcinus spp.) were common at greater depths (>500 m). Other ubiquitous taxa included serpulid and sabellid polychaetes and brittle stars (Ophiocantha sp.). Cold-water corals (Lophelia cf. pertusa), indicative of Vulnerable Marine Ecosystems (VMEs) and representing substantial benthic carbon accumulation, occurred in particularly dense aggregations at <350 m but were encountered as deep as 1020 m. In addition to enhancing marine biodiversity records at this locality, this study provides critical baseline data to support the future management of Ascension's marine environment.
Tephra layers from 11 sediment cores were examined from a series of closely spaced lake and peat sites, which form an arc around the andesitic stratovolcano Mt. Taranaki, North Island, New Zealand. A new high-resolution composite tephra-deposition record was built, encompassing at least 228 tephra-producing eruptions over the last 30 cal ka BP and providing a basis for understanding variations in magnitude and frequency of explosive volcanism at a typical andesitic volcano. Intersite correlation and geochemical fingerprinting of almost all tephra layers was achieved using electron microprobe–determined titanomagnetite phenocryst and volcanic glass shard compositions, in conjunction with precise age determination of the tephra layers based on continuous down-core radiocarbon dating. Compositional variation within these data allowed the overall eruption record to be divided into six individual tephra sequences. This geochemical/stratigraphic division provides a broad basis for widening correlation to incomplete tephra sequences, with confident correlations to specific, distal Taranaki-derived tephra layers found as far as 270 km from the volcano. Furthermore, this tephrostratigraphical record is one of the most continuous and detailed for an andesitic stratovolcano. It suggests two general patterns of magmatic evolution, characterized by intricate geochemical variations indicating a complex storage and plumbing system beneath the volcano.
Although high-sensitivity liquid scintillation (LS) spectroscopy is theoretically capable of producing finite radiocarbon ages in the 50,000- to 70,000-yr range, there is little evidence in the literature that meaningful dates in this time period have been obtained. The pressing need to undertake calibration beyond 26 kyr has resulted in the regular publication of 14C results in excess of 50 kyr, yet very little effort has been made to demonstrate their accuracy or precision. There is a paucity of systematic studies of the techniques required to produce reliable dates close to background and the methods needed to assess contamination from either in situ sources or laboratory handling and processing. We have studied the requirements for producing accurate and reliable dates beyond 50 kyr. Laboratory procedures include optimization of LS spectrometers to obtain low and stable non-14C background count rates, use of low-background counting vials, large benzene volumes, long counting times, and preconditioning of vacuum lines. We also discuss the need for multiple analyses of a suitable material containing no original 14C (background blank) and the application of an appropriate statistical model to compensate for variability in background contamination beyond counting statistics. Accurate and reproducible finite ages >60 kyr are indeed possible by high-sensitivity LS spectroscopy, but require corroborating background blank data to be defensible.
The Queen's University of Belfast, Northern Ireland and University of Waikato, Hamilton, New Zealand radiocarbon laboratories have undertaken a series of high-precision measurements on decadal samples of dendrochronologically dated oak (Quercus patrea) and cedar (Libocedrus bidwillii) from Great Britain and New Zealand, respectively. The results show a real atmospheric offset of 3.4 ± 0.6% (27.2 ± 4.7 14C yr) between the two locations for the interval ad 1725 to ad 1885, with the Southern Hemisphere being depleted in l4C. This result is less than the value currently used to correct Southern Hemisphere calibrations, possibly indicating a gradient in Δ14C within the Southern Hemisphere.
It is well known that radiocarbon years do not directly equate to calendar time. As a result, considerable effort has been devoted to generating a decadally resolved calibration curve for the Holocene and latter part of the last termination. A calibration curve that can be unambiguously attributed to changes in atmospheric 14C content has not, however, been generated beyond 26 kyr cal BP, despite the urgent need to rigorously test climatic, environmental, and archaeological models. Here, we discuss the potential of New Zealand kauri (Agathis australis) to define the structure of the 14C calibration curve using annually resolved tree rings and thereby provide an absolute measure of atmospheric 14C. We report bidecadally sampled 14C measurements obtained from a floating 1050-yr chronology, demonstrating repeatable 14C measurements near the present limits of the dating method. The results indicate that considerable scope exists for a high-resolution 14C calibration curve back through OIS-3 using subfossil wood from this source.
The IntCal04 and Marine04 radiocarbon calibration curves have been updated from 12 cal kBP (cal kBP is here defined as thousands of calibrated years before AD 1950), and extended to 50 cal kBP, utilizing newly available data sets that meet the IntCal Working Group criteria for pristine corals and other carbonates and for quantification of uncertainty in both the 14C and calendar timescales as established in 2002. No change was made to the curves from 0–12 cal kBP. The curves were constructed using a Markov chain Monte Carlo (MCMC) implementation of the random walk model used for IntCal04 and Marine04. The new curves were ratified at the 20th International Radiocarbon Conference in June 2009 and are available in the Supplemental Material at www.radiocarbon.org.
In a separate study, we conducted a series of high-precision radiocarbon measurements using wood from Britain and New Zealand to investigate interhemispheric offsets and possible temporal variations. To minimize variability associated with different species, the pretreatment of the oak (Quercus patraea) and cedar (Librocedrus bidwilli) was to α-cellulose for both. This study investigates the thoroughness of a range of pretreatment processes by the stable isotope analysis of the products.
The Commission again subscribes to a number of the good resolutions it has made in the past, for example, to follow the almost universal practice of counting the observed times, either in decimals of a day or in hours and minutes, from Greenwich mean noon, even though one is convinced that the rest of the world should adopt U.T.; and to prepare a chart, identifying the variable and the comparison stars, to form a part of the discovery announcement of a variable which cannot be easily identified through a Durchmusterung number and which is bright enough to invite further observation.
High-quality data from appropriate archives are needed for the continuing improvement of radiocarbon calibration curves. We discuss here the basic assumptions behind 14C dating that necessitate calibration and the relative strengths and weaknesses of archives from which calibration data are obtained. We also highlight the procedures, problems, and uncertainties involved in determining atmospheric and surface ocean 14C/12C in these archives, including a discussion of the various methods used to derive an independent absolute timescale and uncertainty. The types of data required for the current IntCal database and calibration curve model are tabulated with examples.
The IntCal09 and Marine09 radiocarbon calibration curves have been revised utilizing newly available and updated data sets from 14C measurements on tree rings, plant macrofossils, speleothems, corals, and foraminifera. The calibration curves were derived from the data using the random walk model (RWM) used to generate IntCal09 and Marine09, which has been revised to account for additional uncertainties and error structures. The new curves were ratified at the 21st International Radiocarbon conference in July 2012 and are available as Supplemental Material at www.radiocarbon.org. The database can be accessed at http://intcal.qub.ac.uk/intcal13/.
The Southern Hemisphere SHCal04 radiocarbon calibration curve has been updated with the addition of new data sets extending measurements to 2145 cal BP and including the ANSTO Younger Dryas Huon pine data set. Outside the range of measured data, the curve is based upon the ern Hemisphere data sets as presented in IntCal13, with an interhemispheric offset averaging 43 ± 23 yr modeled by an autoregressive process to represent the short-term correlations in the offset.
Little is known about the relative extent of crime against people with
severe mental illness (SMI).
To assess the prevalence and impact of crime among people with SMI
compared with the general population.
A total of 361 psychiatric patients were interviewed using the national
crime survey questionnaire, and findings compared with those from 3138
general population controls participating in the contemporaneous national
Past-year crime was experienced by 40% of patients v.
14% of controls (adjusted odds ratio (OR) = 2.8, 95% CI 2.0–3.8); and
violent assaults by 19% of patients v. 3% of controls
(adjusted OR = 5.3, 95% CI 3.1–8.8). Women with SMI had four-, ten- and
four-fold increases in the odds of experiencing domestic, community and
sexual violence, respectively. Victims with SMI were more likely to
report psychosocial morbidity following violence than victims from the
People with SMI are at greatly increased risk of crime and associated
morbidity. Violence prevention policies should be particularly focused on
people with SMI.
Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population.
Three hundred and three randomly recruited psychiatric patients, in contact with community services for ⩾1 year, were interviewed using the British Crime Survey domestic/sexual violence questionnaire. Prevalence and correlates of violence in this sample were compared with those from 22 606 general population controls participating in the contemporaneous 2011/12 national crime survey.
Past-year domestic violence was reported by 27% v. 9% of SMI and control women, respectively [odds ratio (OR) adjusted for socio-demographics, aOR 2.7, 95% confidence interval (CI) 1.7–4.0], and by 13% v. 5% of SMI and control men, respectively (aOR 1.6, 95% CI 1.0–2.8). Past-year sexual violence was reported by 10% v. 2.0% of SMI and control women respectively (aOR 2.9, 95% CI 1.4–5.8). Family (non-partner) violence comprised a greater proportion of overall domestic violence among SMI than control victims (63% v. 35%, p < 0.01). Adulthood serious sexual assault led to attempted suicide more often among SMI than control female victims (53% v. 3.4%, p < 0.001).
Compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.
Rutherford backscattering and channeling spectrometry (RBS), photoluminescence (PL) spectroscopy and transmission electron microscopy (TEM) have been used to investigate macroscopic and microscopic segregation in MOCVD grown InGaN layers. The PL peak energy and In content (measured by RBS) were mapped at a large number of distinct points on the samples. An indium concentration of 40%, the highest measured in this work, corresponds to a PL peak of 710 nm, strongly suggesting that the light-emitting regions of the sample are very indium-rich compared to the average measured by RBS. Cross-sectional TEM observations show distinctive layering of the InGaN films. The TEM study further reveals that these layers consist of amorphous pyramidal contrast features with sizes of order 10 nm. The composition of these specific contrast features is shown to be In-rich compared to the nitride matrix.