Evaluation of a combined HIV and geriatrics clinic for older people living with HIV: the Silver clinic in Brighton, UK

As life expectancy in people living with HIV (PLWH) has increased, the focus of management has shifted to preventing and treating chronic illnesses, but few services exist for the assessment and management of these individuals. Here, we provide an initial description of a geriatric service for people living with HIV and present data from a service evaluation undertaken in the clinic. We conducted an evaluation of the first 52 patients seen in the clinic between 2016 and 2019. We present patient demographic data, assessment outcomes, diagnoses given, and interventions delivered to those seen in the clinic. The average age of attendees was 67. Primary reasons for referral to the clinic included management of complex comorbidities, polypharmacy, and suspected geriatric syndrome (falls, frailty, poor mobility, or cognitive decline). The median (range) number of comorbidities and comedications (non-antiretrovirals) was 7 (2–19) and 9 (1–15), respectively. All attendees had an undetectable viral load. Geriatric syndromes were observed in 26 (50%) patients reviewed in the clinic, with frailty and mental health disease being the most common syndromes. Interventions offered to patients included combination antiretroviral therapy modification, further health investigations, signposting to rehabilitation or social care services, and in-clinic advice. High levels of acceptability among patients and healthcare professionals were reported. The evaluation suggests that specialist geriatric HIV services might play a role in the management of older people with HIV with geriatric syndromes

Extended Lattice Light-Sheet with Incoherent Holography

Recently, lattice light-sheet instruments and imaging technology have shown a great improvement in exploring the dynamics of life at subcellular resolution. However, to reconstruct 3-dimensional structures the objective lens or the sample stage are invariably moved. Invention of incoherent holography lattice light-sheet (IHLLS) using FINCH provides quantitative information on the state and size of subcellular changes of neurons over the visible spectrum. The technique allows both faster three-dimensional amplitude as well as phase imaging without moving either sample stage or the detection objective. Amplitude and phase measurements provide intrinsic instrumental simplicity, larger scanning area, and higher resolution when compared to the original LLS schemes. IHLLS is built as an additional detection arm of an original lattice light-sheet (LLS) system. In this chapter, we review the evolution of IHLLS to address its feasibility and limitations

Estimating Internal Wave Energy Fluxes in the Ocean

Energy flux is a fundamental quantity for understanding internal wave generation, propagation, and dissipation. In this paper, the estimation of internal wave energy fluxes from ocean observations that may be sparse in either time or depth are considered. Sampling must be sufficient in depth to allow for the estimation of the internal wave–induced pressure anomaly p′ using the hydrostatic balance, and sufficient in time to allow for phase averaging. Data limitations that are considered include profile time series with coarse temporal or vertical sampling, profiles missing near-surface or near-bottom information, moorings with sparse vertical sampling, and horizontal surveys with no coherent resampling in time. Methodologies, interpretation, and errors are described. For the specific case of the semidiurnal energy flux radiating from the Hawaiian ridge, errors of ~10% are typical for estimates from six full-depth profiles spanning 15 h

Hotspots of deep ocean mixing on the Oregon continental slope

Two deep ocean hotspots of turbulent mixing were found over the Oregon continental slope. Thorpe-scale analyses indicate time-averaged turbulent energy dissipation rates of ε > 10⁻⁷ W/kg and eddy diffusivities of Kp ~ 10⁻² m²/s at both hotspots. However, the structure of turbulence and its generation mechanism at each site appear to be different. At the 2200-m isobath, sustained >100-m high turbulent overturns occur in stratified fluid several hundred meters above the bottom. Turbulence shows a clear 12.4-h periodicity proposed to be driven by flow over a nearby 100-m tall ridge. At the 1300-m isobath, tidally-modulated turbulence of similar intensity is confined within a stratified bottom boundary layer. Along-slope topographic roughness at scales not resolved in global bathymetric data sets appears to be responsible for the bulk of the turbulence observed. Such topography is common to most continental slopes, providing a mechanism for turbulence generation in regions where barotropic tidal currents are nominally along-isobath.Keywords: mixing, internal waves, rough topograph

Global patterns of diapycnal mixing from measurements of the turbulent dissipation rate

The authors present inferences of diapycnal diffusivity from a compilation of over 5200 microstructure profiles. As microstructure observations are sparse, these are supplemented with indirect measurements of mixing obtained from (i) Thorpe-scale overturns from moored profilers, a finescale parameterization applied to (ii) shipboard observations of upper-ocean shear, (iii) strain as measured by profiling floats, and (iv) shear and strain from full-depth lowered acoustic Doppler current profilers (LADCP) and CTD profiles. Vertical profiles of the turbulent dissipation rate are bottom enhanced over rough topography and abrupt, isolated ridges. The geography of depth-integrated dissipation rate shows spatial variability related to internal wave generation, suggesting one direct energy pathway to turbulence. The global-averaged diapycnal diffusivity below 1000-m depth is O(10?4) m2 s?1 and above 1000-m depth is O(10?5) m2 s?1. The compiled microstructure observations sample a wide range of internal wave power inputs and topographic roughness, providing a dataset with which to estimate a representative global-averaged dissipation rate and diffusivity. However, there is strong regional variability in the ratio between local internal wave generation and local dissipation. In some regions, the depth-integrated dissipation rate is comparable to the estimated power input into the local internal wave field. In a few cases, more internal wave power is dissipated than locally generated, suggesting remote internal wave sources. However, at most locations the total power lost through turbulent dissipation is less than the input into the local internal wave field. This suggests dissipation elsewhere, such as continental margins

Three-Dimensional Double-Ridge Internal Tide Resonance in Luzon Strait

The three-dimensional (3D) double-ridge internal tide interference in the Luzon Strait in the South China Sea is examined by comparing 3D and two-dimensional (2D) realistic simulations. Both the 3D simulations and observations indicate the presence of 3D first-mode (semi)diurnal standing waves in the 3.6-km-deep trench in the strait. As in an earlier 2D study, barotropic-to-baroclinic energy conversion, flux divergence, and dissipation are greatly enhanced when semidiurnal tides dominate relative to periods dominated by diurnal tides. The resonance in the 3D simulation is several times stronger than in the 2D simulations for the central strait. Idealized experiments indicate that, in addition to ridge height, the resonance is only a function of separation distance and not of the along-ridge length; that is, the enhanced resonance in 3D is not caused by 3D standing waves or basin modes. Instead, the difference in resonance between the 2D and 3D simulations is attributed to the topographic blocking of the barotropic flow by the 3D ridges, affecting wave generation, and a more constructive phasing between the remotely generated internal waves, arriving under oblique angles, and the barotropic tide. Most of the resonance occurs for the first mode. The contribution of the higher modes is reduced because of 3D radiation, multiple generation sites, scattering, and a rapid decay in amplitude away from the ridge