Prevalence and predictors of cigarette smoking among people with HIV in Western Jamaica.

With highly active antiretroviral therapy, HIV infection has become a treatable chronic disease. However, modifiable risk factors such as cigarette smoking continue to impact the morbidity and mortality of people with HIV (PWH). We assessed the prevalence and factors associated with cigarette smoking and motivation to quit among PWH in Western Jamaica. A cross-sectional study was conducted in which 392 adults seeking HIV care at health facilities in Western Jamaica completed an interviewer-administered questionnaire. Current smoking prevalence among participants was 17.4%. Current smoking was significantly associated with being male (OR = 2.99), non-Christian/non-Rastafarian (OR = 2.34), living or working with another smoker (aOR =1.86), being moderate to severely depressed (OR = 3.24), having an alcohol drinking problem (OR = 1.84), and never being asked by a healthcare provider if they smoked (OR = 3.24). Among the PWH who currently smoke, 36.7% are moderately to highly dependent on nicotine. One-third of people who smoke (33.8%) started smoking for the first time after HIV diagnosis, while 66.2% initiated smoking before; 88% were willing to quit smoking. These findings provide baseline information for designing and implementing a comprehensive smoking cessation program that considers the needs of PWH in Jamaica, with the potential of becoming a replicable model for other HIV-specialized healthcare settings in the Caribbean.

Enhancing routine HIV and STI testing among young men who have sex with men: primary outcomes of the get connected clinical randomized trial (ATN 139).

BACKGROUND: Regular HIV and STI testing remain a cornerstone of comprehensive sexual health care. In this study, we examine the efficacy of Get Connected, a WebApp that combines test locators with personalized educational resources, in motivating young men who have sex with men (YMSM) to undergo regular HIV and STI testing. METHODS: Participants were randomly placed in one of two conditions. The first condition included the full version of GC (GC-PLUS), which included content tailored to users' psychosocial characteristics (e.g., age, race/ethnicity, relationship status, HIV/STI testing history). The second condition served as our attention-control and only included the testing locator (GC-TLO) for HIV/STI testing services. Participants were recruited from three cities (Houston, Philadelphia, and Atlanta) characterized by high HIV incidence. Assessments were collected at 1, 3-, 6-, 9- and 12-month follow-ups. RESULTS: Both versions of GC were acceptable and efficacious in increasing routine HIV and STI testing over a 12-month period. 40% of the sample reported testing at least twice, with no main effects observed across the two intervention arms (OR = 1.11; 95% CI: 0.69, 1.80), p =.66). Greater intervention effects were observed among YMSM who engaged more frequently with the intervention, with regional differences observed. CONCLUSIONS: Our findings underscore the need to cater to the diverse needs of YMSM through multilevel approaches. Broadly, mHealth HIV/STI testing interventions, such as Get Connected, would benefit from matching technologies to the local context to have the greatest impact. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov (NCT03132415).

Real-world application of tumor mutational burden-high (TMB-high) and microsatellite instability (MSI) confirms their utility as immunotherapy biomarkers.

INTRODUCTION: Microsatellite instability (MSI) testing and tumor mutational burden (TMB) are genomic biomarkers used to identify patients who are likely to benefit from immune checkpoint inhibitors. Pembrolizumab was recently approved by the Food and Drug Administration for use in TMB-high (TMB-H) tumors, regardless of histology, based on KEYNOTE-158. The primary objective of this retrospective study was real-world applicability and use of immunotherapy in TMB/MSI-high patients to lend credence to and refine this biomarker. METHODS: Charts of patients with advanced solid tumors who had MSI/TMB status determined by next generation sequencing (NGS) (FoundationOne CDx) were reviewed. Demographics, diagnosis, treatment history, and overall response rate (ORR) were abstracted. Progression-free survival (PFS) was determined from Kaplan-Meier curves. PFS1 (chemotherapy PFS) and PFS2 (immunotherapy PFS) were determined for patients who received immunotherapy after progressing on chemotherapy. The median PFS2/PFS1 ratio was recorded. RESULTS: MSI-high or TMB-H [≥20 mutations per megabase (mut/MB)] was detected in 157 adults with a total of 27 distinct tumor histologies. Median turnaround time for NGS was 73 days. ORR for most recent chemotherapy was 34.4%. ORR for immunotherapy was 55.9%. Median PFS for patients who received chemotherapy versus immunotherapy was 6.75 months (95% confidence interval, 3.9-10.9 months) and 24.2 months (95% confidence interval, 9.6 months to not reached), respectively (P = 0.042). Median PFS2/PFS1 ratio was 4.7 in favor of immunotherapy. CONCLUSION: This real-world study reinforces the use of TMB as a predictive biomarker. Barriers exist to the timely implementation of NGS-based biomarkers and more data are needed to raise awareness about the clinical utility of TMB. Clinicians should consider treating TMB-H patients with immunotherapy regardless of their histology.

Concordance in the reporting of intimate partner violence among male-male couples.

Intimate partner violence (IPV) among male couples is increasingly recognized as a public health concern. Research on IPV in opposite sex couples indicates frequent underreporting of IPV and high levels of discordance in reporting among dyads. Concordance studies inform refinement methods to measure the experience of IPV among dyads; however the lack of dyadic studies of male couples impedes our understanding of the extent to which IPV is differentially reported in male-male dyads. This study utilized baseline data from a randomized controlled trial of a behavioral intervention to optimize antiretroviral therapy (ART) adherence among 160 sero-discordant male couples in three US cities and provides the first analysis of concordance in reporting IPV among male couples. Low degrees of concordance in the reporting of IPV were identified among male dyads, with a greater proportion of men reporting violence perpetration than experiencing violence. The greater reporting of IPV perpetration may be linked to adherence to concepts of masculinity. The results underscore the unique experiences of IPV among male couples and the need to reexamine current IPV measurement and intervention strategies.

Isometric Finger Pose Recognition with Sparse Channel SpatioTemporal EMG Imaging.

High fidelity myoelectric control of prostheses and orthoses isparamount to restoring lost function to amputees and neuro-muscular disease sufferers. In this study we prove that patio-temporal imaging can be used to allow convolutional neural networks to classify sparse channel EMG samples from a consumer-grade device with over 94 % accuracy. 10,572 images are generated from 960 samples of simple and complex isometric finger poses recorded from 4 fully intact subjects. Real-time classification of 12 poses is achieved with a 250ms continuous overlapping window.

Swimming Against the Current: A Qualitative Review of the Work Experiences and Adaptations Made by Employees With Arthritis.

OBJECTIVE: To describe the experiences and strategies of employees with arthritis to maintain employment, and to use this information to build a conceptual model. METHODS: We conducted a systematic review of qualitative studies that examined the work experiences of employees with arthritis. Published studies on arthritis and employment were searched from electronic databases (1980-2017) and bibliographic reviews of relevant studies. We used meta-ethnography to synthesize the findings. RESULTS: We reviewed 17 studies that reported on the experiences of 873 employees. We identified 11 main themes that highlight common issues experienced by employees with arthritis and grouped these into 4 higher-order categories: changing nature of the disease (emotional issues, cognitive struggles, unpredictable physical symptoms), intrapersonal issues (personal meaning of work, preserving a work identity), interpersonal issues (managing disclosure, gaining coworker support, organizational culture issues), and work-sustainability strategies (making personal adjustments, using social support, using workplace accommodations). Using these themes, we developed the Job Sustainability Model to illustrate how disease, personal, and work-related factors interact to influence what type of coping behaviors are used and when. Initially, employees with arthritis rely on making personal adjustments, using social support, and medical intervention. However, when these coping behaviors fail to be effective, they draw upon workplace accommodations and resources. CONCLUSION: Arthritis disrupts an employee's work life by impairing his or her capacity to be a productive worker. Our results highlight how employees with arthritis make strategic adaptations to maintain a productive work life for as long as possible. The findings of this study have implications for work-related interventions aimed at preserving employment.

Targeting the mannose receptor with mannosylated subunit vaccines.

The mannose receptor (MR) is an important component of the immune system and understanding the structural and conformational characteristics of this receptor is a key aspect of vaccine design. Improved understanding of the role of carbohydrate recognition domains 4-7 (CRDs 4-7) in recognising glycosylated ligands present on the surface of pathogens such as C.albicans, P. carinii, L. donovani, and M. tuberculosis has given new insight into MR vaccine development. Initial studies identified mannan and its derivatives to be important ligands in MR targeting, providing essential knowledge about the MR structural properties. The MR was found to be an early responder in immunogenic pathways. Many attempts have been made to mimic the structural properties of yeast mannan by attaching mannan or mannose to antigenic proteins or peptide epitopes. However, a more detailed understanding of the structural properties of the MR is necessary for the design of targeted vaccines. This review describes the structure of the MR and provides an overview of the use of mannosylated proteins and peptides for vaccine targeting.

The Posttraumatic Growth Inventory: factor structure and invariance among persons with chronic diseases.

OBJECTIVE: The Posttraumatic Growth Inventory (PTGI) assesses positive changes after a traumatic or serious life crisis. However, there are differing views regarding its factor structure and little understanding if it captures the positive changes experienced among individuals diagnosed with a chronic disease. Using confirmatory factor analysis (CFA), the proposed five-factor structure and measurement invariance of the PTGI was examined using two chronic illness samples: arthritis and inflammatory bowel disease (IBD). METHOD: Individuals diagnosed with arthritis (n = 301) or IBD (n = 544) recruited from the community and the Internet completed the PTGI. Using a pooled sample, CFA tested five hypothesized models of the underlying factors structure of the PTGI. A stepwise procedure for testing the measurement invariance across the two groups evaluated the factor structure, factorial invariance, and latent mean invariance. RESULTS: Using the pooled sample, the CFA supported the hypothesized five-factor model, revealing the PTGI is multidimensional. Multigroup CFA supported invariance of the PTGI across the two groups although there were significant differences in latent means. CONCLUSIONS: The findings support that the PTGI assesses five related dimensions of PTG and that different chronic disease groups experience different types of positive changes. PTG may therefore be relevant as a meaningful treatment goal for people with chronic diseases as it is for people affected by other traumatic events.

Drosophila melanogaster: a fly through its history and current use.

Drosophila melanogaster, the common fruit fly, has been used as a model organism in both medical and scientific research for over a century. Work by Thomas Hunt Morgan (1866-1945) and his students at Columbia University at the beginning of the twentieth century led to great discoveries such as sex-linked inheritance and that ionising radiation causes mutations in genes. However, the use of Drosophila was not limited to genetic research. Experimentation with this model organism has also led to discoveries in neuroscience and neurodevelopment, including the basis of circadian rhythms. Its complex nervous system, conserved neurological function, and human disease-related loci allow Drosophila to be an ideal model organism for the study of neurodegenerative disease, for which it is used today, aiding research into diseases such as Alzheimer's and Parkinson's, which are becoming more prevalent in today's ageing population.

Tunneling through superlattices: the effect of anisotropy and kinematic coupling.

The tunneling of carriers in stratified superlattice systems is analyzed in terms of the constituent effective mass tensor. The focus is on the effects on the tunneling which are caused by the side regions of an intervening barrier. Depending on the covalency and work function in the constituent layers of a superlattice, it is concluded that the kinematics in the regions on either side determined by the effective carrier mass and its interference with the band offset at heterojunctions leads to either a constructive or a destructive effect on the tunneling current. As an example, Si(1-x)Ge(x)/Si and Al(x)Ga(1-x)As/GaAs superlattices are demonstrated to reduce the tunneling current at certain fractional thicknesses and stoichiometries of the constituent slabs without affecting the lateral mobility. The findings show, in general, how manipulation of the carrier's effective mass tensor through stoichiometric/structural modulation of the heterostructure may be used to control the tunneling current through a given potential barrier, given that the characteristic de Broglie wavelength exceeds all the constituent dimensions, thus offering a method complementary to high-k technologies.

Knowledge, attitudes and behaviours associated with the provision of hepatitis C care by Canadian family physicians.

The role of primary care physicians in providing care for hepatitis C virus (HCV) infection is increasingly emphasized, but many gaps and challenges remain. This study explores family physicians' knowledge, attitudes and practices associated with providing care for HCV infection. Seven hundred and forty-nine members of the College of Family Physicians of Canada (CFPC) completed a self-administered survey examining knowledge, attitudes and behaviours regarding HCV infection screening and care. Multivariate analyses were performed using the outcome, HCV care provision, and variables based on a conceptual model of practice guideline adherence. Family physicians providing basic-advanced HCV care were more likely to be older, practice in a rural setting, have injection drug users (IDU) in their practice and have higher levels of knowledge about the initial assessment (OR = 1.77; 95% CI = 1.23-2.54) and treatment of HCV (OR = 1.74; 95% CI = 1.24-2.43). They were also less likely to believe that family physicians do not have a role in HCV care (OR = 0.41; 95% CI = 0.30-0.58). Educational programmes should target physicians less likely to provide HCV care, namely family physicians practicing in urban areas and those who do not care for any IDU patients. Training and continuing medical education programmes that aim to shift family physicians' attitudes about the provision of HCV care by promoting their roles as integral to HCV care could contribute to easing the burden on consultant physicians and lead to improved access to treatment for HCV infection.

Spangolite: an s = 1/2 maple leaf lattice antiferromagnet?

Spangolite, Cu(6)Al(SO(4))(OH)(12)Cl·3H(2)O, is a hydrated layered copper sulfate mineral. The Cu(2+) ions of each layer form a systematically depleted triangular lattice which approximates a maple leaf lattice. We present details of the crystal structure, which suggest that in spangolite this lattice actually comprises two species of edge linked trimers with different exchange parameters. However, magnetic susceptibility measurements show that despite the structural trimers, the magnetic properties are dominated by dimerization. The high temperature magnetic moment is strongly reduced below that expected for the six s = 1/2 in the unit cell.

Small-scale mantle convection produces stratigraphic sequences in sedimentary basins.

Cyclic sedimentary deposits link stratigraphic sequences that are now geographically distant but were once part of the same depositional environment. Some of these sequences occur at periods of 2 to 20 million years, and eustatic sea-level variations or regional tectonic events are likely causes of their formation. Using numerical modeling, we demonstrate that small-scale mantle convection can also cause the development of stratigraphic sequences through recurrent local and regional vertical surface movements. Small-scale convection-driven stratigraphic sequences occur at periods of 2 to 20 million years and correlate only at distances up to a few hundred kilometers. These results suggest that previous sequence stratigraphic analyses may contain erroneous conclusions regarding eustatic sea-level variations.

Bioavailability of xenobiotics in the soil environment.

It is often presumed that all chemicals in soil are available to microorganisms, plant roots, and soil fauna via dermal exposure. Subsequent bioaccumulation through the food chain may then result in exposure to higher organisms. Using the presumption of total availability, national governments reduce environmental threshold levels of regulated chemicals by increasing guideline safety margins. However, evidence shows that chemical residues in the soil environment are not always bioavailable. Hence, actual chemical exposure levels of biota are much less than concentrations present in soil would suggest. Because "bioavailability" conveys meaning that combines implications of chemical sol persistency, efficacy, and toxicity, insights on the magnitude of a chemicals soil bioavailability is valuable. however, soil bioavailability of chemicals is a complex topic, and is affected by chemical properties, soil properties, species exposed, climate, and interaction processes. In this review, the state-of-art scientific basis for bioavailability is addressed. Key points covered include: definition, factors affecting bioavailability, equations governing key transport and distributive kinetics, and primary methods for estimating bioavailability. Primary transport mechanisms in living organisms, critical to an understanding of bioavailability, also presage the review. Transport of lipophilic chemicals occurs mainly by passive diffusion for all microorganisms, plants, and soil fauna. Therefore, the distribution of a chemical between organisms and soil (bioavailable proportion) follows partition equilibrium theory. However, a chemical's bioavailability does not always follow partition equilibrium theory because of other interactions with soil, such as soil sorption, hysteretic desorption, effects of surfactants in pore water, formation of "bound residue", etc. Bioassays for estimating chemical bioavailability have been introduced with several targeted endpoints: microbial degradation, uptake by higher plants and soil fauna, and toxicity to organisms. However, there bioassays are often time consuming and laborious. Thus, mild extraction methods have been employed to estimate bioavailability of chemicals. Mild methods include sequential extraction using alcohols, hexane/water, supercritical fluids (carbon dioxide), aqueous hydroxypropyl-beta-cyclodextrin extraction, polymeric TENAX beads extraction, and poly(dimethylsiloxane)-coated solid-phase microextraction. It should be noted that mild extraction methods may predict bioavailability at the moment when measurements are carried out, but not the changes in bioavailability that may occur over time. Simulation models are needed to estimate better bioavailability as a function of exposure time. In the past, models have progressed significantly by addressing each group of organisms separately: microbial degradation, plant uptake via evapotranspiration processes, and uptake of soil fauna in their habitat. This approach has been used primarily because of wide differences in the physiology and behaviors of such disparate organisms. However, improvement of models is badly needed, Particularly to describe uptake processes by plant and animals that impinge on bioavailability. Although models are required to describe all important factors that may affect chemical bioavailability to individual organisms over time (e.g., sorption/desorption to soil/sediment, volatilization, dissolution, aging, "bound residue" formation, biodegradation, etc.), these models should be simplified, when possible, to limit the number of parameters to the practical minimum. Although significant scientific progress has been made in understanding the complexities in specific methodologies dedicated to determining bioavailability, no method has yet emerged to characterized bioavailability across a wide range of chemicals, organisms, and soils/sediments. The primary aim in studying bioavailability is to define options for addressing bioremediation or environmental toxicity (risk assessment), and that is unlikely to change. Because of its importance in estimating research is needed to more comprehensively address the key environmental issue of "bioavailability of chemicals in soil/sediment."

Wheat and sorghum residue removal for expanded uses increases sediment and nutrient loss in runoff.

Crop residue removal for expanded uses such as feedstocks for cellulosic ethanol production may increase loss of sediment and nutrients in runoff. We assessed on-farm impacts of variable rates of residue removal from no-till winter wheat (Triticum aestivum L.) and plow till grain sorghum [Sorghum bicolor (L.) Moench] on sediment, soil organic carbon (SOC) and nutrient losses in runoff in western Kansas. Five treatments with three replications consisting of removing residues at 0, 25, 50, 75, and 100% after harvest under two tillage levels for wheat (no-till and freshly tilled) and grain sorghum (spring tilled and freshly tilled) were established on 1x2 m plots. Simulated rainfall was applied at 115+/-3 mm h(-1) for 30 min. Compared with plots without residue removal, complete removal increased runoff by 61% in freshly tilled wheat plots, 225% in spring-tilled sorghum plots, and 94% in freshly tilled sorghum plots. Residue removal at rates as low as 50% increased loss of sediment. Complete removal doubled the sediment loss to 14 Mg ha(-1) in tilled wheat, whereas it increased sediment loss from 0.9 to 7.2 Mg ha(-1) in no-till wheat. No-till with 100% residue removal lost as much sediment as freshly tilled wheat plots with 0 or 25% removal. Residue removal at 75 and 100% increased losses of total N, total P, and SOC associated with sediment. Overall, excessive residue removal led to large losses of sediment, sediment-bound SOC, and nutrients in runoff. Furthermore, erosion protection provided by no-till management is lost when residue removal exceeds 25%.

The impact of project closure on HIV incidence and mortality in a cohort of couples in Lusaka, Zambia.

The objective of this study was to assess the impact of temporary closure of an HIV research clinic on the health of study participants. Primary data were collected quarterly from couples enrolled in research studies at an established HIV study site. There were 632 participating couples enrolled when the project closed, 475 of whom returned when it re-opened six months later. HIV sero-incidence, mortality rates and risk-taking behaviours were compared before and during the closure. Perceived impact of the closure was measured in returning participants. Demographic data collected at the last pre-closure study visit were used to look at the differences between returning and non-returning study participants. Serologic data from those who returned were compared pre- and post-closure to examine changes in HIV incidence. Mortality rates were estimated from reported deaths, and were compared pre- and during project closure. Perceptions of the impact of the closure among returning participants were examined through an interviewer administered questionnaire. It was found that couples who returned were not demographically different from couples who did not return. Most participants reported no problems with finding alternate sources of condoms and the incidence of HIV did not change significantly during the closure. Eighty-four percent respondents reported that the closure had a negative impact on them, 87% of whom rated loss of medical care as the main impact. The mortality rate among HIV-positive participants doubled from 6.7/100 person years to 12.4/100 person years during the closure (p=0.01). Results indicate that couples voluntary counselling and testing (CVCT) established durable risk-reduction behaviours that persisted during project closure. ThIn ae loss of healthcare was perceived as the most negative impact on participants, reflected in increased mortality rates. Research projects should make transition plans and budget for mechanisms to reduce the negative impact on participants of project closures.

The demographic profile of sero-discordant couples enrolled in clinical research in Rwanda and Zambia.

This paper examines the demographic profile of two cohorts of sero-discordant couples enrolled in research activities at two clinical research sites in Kigali, Rwanda and Lusaka, Zambia and compares their background characteristics by country, gender and sero-status. Differences between the two cohorts represent economic and cultural differences between the two countries. Recruitment procedures appear to be successful in reaching the intended audience - couples from poor urban communities - and we suggest that similar recruitment strategies could be adopted to reach other population groups in other settings. The profiles of sero-discordant couples highlight several potential intervention points, and call for attention to be focused towards prevention efforts aimed at young women and their male partners.

The influence of motivational messages on future planning behaviors among HIV concordant positive and discordant couples in Lusaka, Zambia.

In Zambia the HIV/AIDS epidemic has resulted in many single female-headed households. Strong patriarchal laws and customs prevent widows and children from maintaining economic assets. This study examines the impact of a video-based motivational intervention promoting future planning in 1,504 HIV-infected couples in Lusaka, Zambia. Following a group video session, couples randomized to the motivational arm could choose to write a will, identify a guardian for their children and make financial plans. Desirable behaviours modelled in the motivational video were measured at quarterly intervals for a year and compared in intervention and control arms. Demographic measures including age, income and educational status were not associated with planning behaviours. Participation in the intervention was associated with will writing (23% versus 5%) and naming a guardian (32% versus 17%) but not with other planning behaviours. The study demonstrates the ability of motivational messages integrated into HIV VCT to encourage future planning behaviour and points to the need to expand existing HIV and VCT services to meet other non-health needs of those living with HIV.