Predictors of Missed Hepatitis C Intake Appointments and Failure to Establish Hepatitis C Care Among Patients Living With HIV.

BackgroundWe estimated and characterized the proportion of patients living with HIV (PLWH) who missed hepatitis C (HCV) intake appointments and subsequently failed to establish HCV care.MethodsLogistic regression analyses were used to identify factors associated with missed HCV intake appointments and failure to establish HCV care among PLWH referred for HCV treatment between January 2014 and December 2017. In addition to demographics, variables included HIV treatment characteristics, type of insurance, liver health status, active alcohol or illicit drug use, unstable housing, and history of a mental health disorder (MHD).ResultsDuring the study period, 349 new HCV clinic appointments were scheduled for 202 unduplicated patients. Approximately half were nonwhite, and 80% had an undetectable HIV viral load. Drug use (31.7%), heavy alcohol use (32.8%), and MHD (37.8%) were prevalent. Over the 4-year period, 21.9% of PLWH referred for HCV treatment missed their HCV intake appointment. The proportion increased each year, from 17.2% in 2014 to 25.4% in 2017 (P = .021). Sixty-six of the 202 newly referred HCV patients (32.7%) missed their first HCV appointment, and 28 of these (42.4%) failed to establish HCV care. Having a history of MHD, CD4 <200, ongoing drug use, and being nonwhite were independent predictors of missing an intake HCV appointment. The strongest predictor of failure to establish HCV care was having a detectable HIV viral load.ConclusionsThe proportion of PLWH with missed HCV appointments increased over time. HCV elimination among PLWH may require integrated treatment of MHD and substance use

Decision-Making and Sustainable Drainage: Design and Scale

Sustainable Drainage (SuDS) improves water quality, reduces runoff water quantity, increases amenity and biodiversity benefits, and can also mitigate and adapt to climate change. However, an optimal solution has to be designed to be fit for purpose. Most research concentrates on individual devices, but the focus of this paper is on a full management train, showing the scale-related decision-making process in its design with reference to the city of Coventry, a local government authority in central England. It illustrates this with a large scale site-specific model which identifies the SuDS devices suitable for the area and also at the smaller scale, in order to achieve greenfield runoff rates. A method to create a series of maps using geographical information is shown, to indicate feasible locations for SuDS devices across the local government authority area. Applying the larger scale maps, a management train was designed for a smaller-scale regeneration site using MicroDrainage® software to control runoff at greenfield rates. The generated maps were constructed to provide initial guidance to local government on suitable SuDS at individual sites in a planning area. At all scales, the decision about which device to select was complex and influenced by a range of factors, with slightly different problems encountered. There was overall agreement between large and small scale models

Update on Progress of Space Station Integrated Kinetic Launcher for Orbital Payload Systems (SSIKLOPS) - Cyclops

The Space Station Integrated Kinetic Launcher for Orbital Payload Systems (SSIKLOPS), known as "Cyclops" to the International Space Station (ISS) community, was introduced last August (2013) during Technical Session V: From Earth to Orbit of the 27th Annual AIAA/USU Conference on Small Satellites. Cyclops is a collaboration between the NASA ISS Program, NASA Johnson Space Center Engineering, and Department of Defense (DoD) Space Test Program (STP) communities to develop a dedicated 50100 kg class ISS small satellite deployment system. This paper will address the progress of Cyclops through its fabrication, assembly, flight certification, and onorbit demonstration phases. It will also go into more detail regarding its anatomy, its satellite deployment concept of operations, and its satellite interfaces and requirements. Cyclops is manifested to fly on SpaceX 4 which is currently scheduled in July 2014 with its initial satellite deployment demonstration of DoD STP's SpinSat and UT/TAMU's Lonestar satellites being late summer or fall of 2014

Predictive validity of a brief antiretroviral adherence index: Retrospective cohort analysis under conditions of repetitive administration

<p>Abstract</p> <p>Background</p> <p>Newer antiretroviral (ARV) agents have improved pharmacokinetics, potency, and tolerability and have enabled the design of regimens with improved virologic outcomes. Successful antiretroviral therapy is dependent on patient adherence. In previous research, we validated a subset of items from the ACTG adherence battery as prognostic of virologic suppression at 6 months and correlated with adherence estimates from the Medication Event Monitoring System (MEMS). The objective of the current study was to validate the longitudinal use of the Owen Clinic adherence index in analyses of time to initial virologic suppression and maintenance of suppression.</p> <p>Results</p> <p>278 patients (naïve n = 168, experienced n = 110) met inclusion criteria. Median [range] time on the first regimen during the study period was 286 (30 – 1221) days. 217 patients (78%) achieved an undetectable plasma viral load (pVL) at median 63 days. 8.3% (18/217) of patients experienced viral rebound (pVL > 400) after initial suppression. Adherence scores varied from 0 – 25 (mean 1.06, median 0). The lowest detectable adherence score cut point using this instrument was ≥ 5 for both initial suppression and maintenance of suppression. In the final Cox model of time to first undetectable pVL, controlling for prior treatment experience and baseline viral load, the adjusted hazard ratio for time updated adherence score was 0.36_{score ≥ 5}(95% CI: 0.19–0.69) [reference: <5]. In the final generalized estimating equations (GEE) logistic regression model the adjusted odds ratio for time-updated adherence score was 0.17_{score ≥ 5}(0.05–0.66) [reference: <5].</p> <p>Conclusion</p> <p>A brief, longitudinally administered self report adherence instrument predicted both initial virologic suppression and maintenance of suppression in patients using contemporary ARV regimens. The survey can be used for identification of sub-optimal adherence with subsequent appropriate intervention.</p

Paving the Way for Small Satellite Access to Orbit: Cyclops’ Deployment of SpinSat, the Largest Satellite ever Deployed from the International Space Station

The Space Station Integrated Kinetic Launcher for Orbital Payload Systems (SSIKLOPS), known as “Cyclops” to the International Space Station (ISS) community, successfully deployed the largest satellite ever (SpinSat) from the ISS on November 28, 2014. Cyclops, a collaboration between the NASA ISS Program, NASA Johnson Space Center Engineering, and Department of Defense Space Test Program (DoD STP) communities, is a dedicated 10-100 kg class ISS small satellite deployment system. This paper will showcase the successful deployment of SpinSat from the ISS. It will also outline the concept of operations, interfaces, requirements, and processes for satellites to utilize the Cyclops satellite deployment system

Space Station Integrated Kinetic Launcher for Orbital Payload Systems (SSIKLOPS) - Cyclops

Access to space for satellites in the 50-100 kg class is a challenge for the small satellite community. Rideshare opportunities are limited and costly, and the small sat must adhere to the primary payloads schedule and launch needs. Launching as an auxiliary payload on an Expendable Launch Vehicle presents many technical, environmental, and logistical challenges to the small satellite community. To assist the community in mitigating these challenges and in order to provide the community with greater access to space for 50-100 kg satellites, the NASA International Space Station (ISS) and Engineering communities in collaboration with the Department of Defense (DOD) Space Test Program (STP) is developing a dedicated 50-100 kg class ISS small satellite deployment system. The system, known as Cyclops, will utilize NASA's ISS resupply vehicles to launch small sats to the ISS in a controlled pressurized environment in soft stow bags. The satellites will then be processed through the ISS pressurized environment by the astronaut crew allowing satellite system diagnostics prior to orbit insertion. Orbit insertion is achieved through use of the Japan Aerospace Exploration Agency's Experiment Module Robotic Airlock (JEM Airlock) and one of the ISS Robotic Arms. Cyclops' initial satellite deployment demonstration of DOD STP's SpinSat and UT/TAMU's Lonestar satellites will be toward the end of 2013 or beginning of 2014. Cyclops will be housed on-board the ISS and used throughout its lifetime. The anatomy of Cyclops, its concept of operations for satellite deployment, and its satellite interfaces and requirements will be addressed further in this paper

Minocycline 200 mg or 400 mg versus placebo for mild Alzheimer's disease: the MADE Phase II, three-arm RCT

Background: Minocycline is an anti-inflammatory drug and protects against the toxic effects of β-amyloid in vitro and in animal models of Alzheimer’s disease. To the best of our knowledge, no randomised placebo-controlled clinical trials in patients with Alzheimer’s disease looking at the efficacy and tolerability of minocycline have been carried out. Objectives: The trial investigated whether or not minocycline was superior to placebo in slowing down the rate of decline in cognitive and functional ability over 2 years. The safety and tolerability of minocycline were also assessed. Design: A Phase II, three-arm, randomised, double-blind, multicentre trial with a semifactorial design. Participants continued on trial treatment for up to 24 months. Setting: Patients were identified from memory services, both within the 32 participating NHS trusts and within the network of memory services supported by the Dementias and Neurodegenerative Diseases Research Network (also known as DeNDRoN). Participants: Patients with standardised Mini Mental State Examination scores of > 23 points and with Alzheimer’s disease assessed by the National Institute on Aging–Alzheimer’s Association’s criteria were identified from memory services. Intervention: Patients with mild Alzheimer’s disease were randomly allocated 1 : 1 : 1 to receive one of three treatments: arm 1 – 400 mg per day of minocycline; arm 2 – 200 mg per day of minocycline; or arm 3 – placebo. Patients continued treatment for 24 months. Participants, investigators and outcome assessors were blind to treatment allocation. Main outcome measures: Primary outcome measures were decline in standardised Mini Mental State Examination and Bristol Activities of Daily Living Scale scores of combined minocycline treatment arms versus placebo, as analysed by intention-to-treat repeated measures regression. Results: Between 23 May 2014 and 14 April 2016, 554 participants were randomised. Of the 544 eligible participants, the mean age was 74.3 years and the average standardised Mini Mental State Examination score was 26.4 points. A total of 252 serious adverse events were reported, with the most common categories being neuropsychiatric and cardiocirculatory. Significantly fewer participants completed treatment with 400 mg of minocycline [29% (53/184)] than 200 mg [62% (112/181)] or placebo [64% (114/179)] (p < 0.0001), mainly because of gastrointestinal symptoms (p = 0.0008), dermatological side effects (p = 0.02) and dizziness (p = 0.01). Assessment rates were also lower in the 400-mg treatment arm: 68% (119 of 174 expected) for standardised Mini Mental State Examination scores at 24 months, compared with 82% (144/176) for the 200-mg treatment arm and 84% (140/167) for the placebo arm. Decline in standardised Mini Mental State Examination scores over the 24-month study period in the combined minocycline arms was similar to that in the placebo arm (4.1- vs. 4.3-point reduction; p = 0.9), as was the decline in the 400- and 200-mg treatment arms (3.3 vs. 4.7 points; p = 0.08). Likewise, worsening of Bristol Activities of Daily Living Scale scores over 24 months was similar in all trial arms (5.7, 6.6 and 6.2 points in the 400-mg treatment arm, 200-mg treatment arm and placebo arm, respectively; a p-value of 0.57 for minocycline vs. placebo and a p-value of 0.77 for 400 vs. 200 mg of minocycline). Results were similar in different patient subgroups and in sensitivity analyses adjusting for missing data. Limitations: Potential limitations of the study include that biomarkers were not used to confirm the diagnosis of Alzheimer’s disease, as these and apolipoprotein E (APOE) genotyping are not routinely available within the NHS. Compliance was also worse than expected and differential follow-up rates were observed, with fewer assessments obtained for the 400-mg treatment arm than for the 200-mg treatment and placebo arms. Conclusions: Minocycline does not delay the progress of cognitive or functional impairment in people with mild Alzheimer’s disease over a 2-year period. Minocycline at a dose of 400 mg is poorly tolerated in this population. Future work: The Minocycline in mild Alzheimer’s DiseasE (MADE) study provides a framework for a streamlined trial design that can be usefully applied to test other disease-modifying therapies

Messina (\u3cem\u3eMelilotus siculus\u3c/em\u3e)–A New Pasture Legume for Saltland

Messina (Melilotus siculus ((Turra) Vitman ex B.D. Jacks)) is a new annual pasture legume for saltland in temperate Australia and regions of the world that experience Mediterranean climates. Messina has greater tolerance to the combined stresses of salinity and water-logging than existing commercial pasture legumes. Coupled with desirable agronomic traits these characteristics give messina the capacity to rehabilitate saltland and increase productivity on land where existing legumes fail. This paper reviews the agronomic perform-ance of messina in relation to top soil salinity levels