Towards Targeted Screening for Acute HIV Infections in British Columbia

Background: Our objective was to describe the characteristics of acute and established HIV infections diagnosedin the Canadian province of British Columbia. Province-wide HIV testing and surveillance data were analyzed toinform recommendations for targeted use of screening algorithms to detect acute HIV infections.Methods: Acute HIV infection was defined as a confirmed reactive HIV p24 antigen test (or HIV nucleic acid test), anon-reactive or reactive HIV EIA screening test and a non-reactive or indeterminate Western Blot. Characteristics ofunique individuals were identified from the British Columbia HIV/AIDS Surveillance System. Primary drug resistanceand HIV subtypes were identified by analyzing HIV pol sequences from residual sera from newly infectedindividuals.Results: From February 2006 to October 2008, 61 individuals met the acute HIV infection case definition,representing 6.2% of the 987 newly diagnosed HIV infections during the analysis period. Acute HIV infection caseswere more likely to be men who have sex with men (crude OR 1.71; 95% CI 1.01-2.89], to have had a documentedprevious negative HIV test result (crude OR 2.89; 95% CI 1.52-5.51), and to have reported a reason for testing dueto suspected seroconversion symptoms (crude OR 5.16; 95% CI 2.88-9.23). HIV subtypes and rates of transmitteddrug resistance across all classes of drugs were similar in persons with both acute and established HIV infections.Conclusions: Targeted screening to detect acute HIV infection is a logical public health response to the HIVepidemic. Our findings suggest that acute HIV infection screening strategies, in our setting, are helpful for earlydiagnosis in men who have sex with men, in persons with seroconversion symptoms and in previously negativerepeat testers

The ischaemic constellation: an alternative to the ischaemic cascade—implications for the validation of new ischaemic tests

The ischaemic cascade is the concept that progressive myocardial oxygen supply–demand mismatch causes a consistent sequence of events, starting with metabolic alterations and followed sequentially by myocardial perfusion abnormalities, wall motion abnormalities, ECG changes, and angina. This concept would suggest that investigations that detect expressions of ischaemia earlier in the cascade should be more sensitive tests of ischaemia than those that detect expressions appearing later in the cascade. However, careful review of the studies on which the ischaemic cascade is based suggests that the ischaemic cascade concept may be less well supported by the literature than assumed. In this review we explore this, discuss an alternative method for conceptualising ischaemia, and discuss the potential implications of this new approach to clinical studies and clinical practice

Detection of Early Sero-Conversion HIV Infection Using the INSTITM HIV-1 Antibody Point-of-Care Test

We compared the INSTITM HIV-1 Antibody Point-of-Care (POC) Test to laboratory-based tests for detection of early sero-conversion (i.e. acute) HIV infections. Fifty-three (53) individuals with early HIV infection, (i.e. 3rd generation anti-HIV EIA non-reactive or reactive, HIV-1 Western Blot non-reactive or indeterminate and HIV-1 p24 antigen reactive) were tested by INSTITM. The INSTITM test was reactive for 34/49 (sensitivity 69.4%; 95% confidence interval 54.6-81.8%) early-infected individuals whose laboratory-based 3rd generation HIV EIA test was reactive. Four (4) were non-reactive by both the laboratory-based EIA and INSTITM tests, but were p24 antigen reactive. The INSTITM POC test performs well compared with other POC tests for the detection of early sero-conversion HIV infection, but it may miss 20% to 30% of those detected by laboratory-based 3rd generation anti-HIV tests. Both POC and laboratory-based anti-HIV tests will fail to detect a proportion of infected individuals in the first weeks after infection

Origin and significance of 'dispersed facies' basal ice: Svínafellsjökull, Iceland

Dispersed facies basal ice - massive (i.e. structureless) ice with dispersed debris aggregates - is present at the margins of many glaciers and, as a product of internal glacial processes, has the potential to provide important information about the mechanisms of glacier flow and the nature of the subglacial environment. The origin of dispersed facies is poorly understood, with several hypotheses having been advanced for its formation, and there is disagreement as to whether it is largely a sedimentary or a tectonic feature. We test these established hypotheses at the temperate glacier Svfnafellsjokull, Iceland, and find that none fully account for dispersed facies characteristics at this location. Instead, dispersed facies physical, sedimentological and stable-isotope (5180, 8D) characteristics favour a predominantly tectonic origin that we suggest comprises the regelation and straininduced metamorphism of debris-rich basal ice that has been entrained into an englacial position by tectonic processes operating at the base of an icefall. Further thickening of the resultant dispersed facies may also occur tectonically as a result of ice flow against the reverse bed slope of a terminal overdeepening. Lack of efficient subglacial drainage in the region of the overdeepening may limit basal melting and thus favour basal ice preservation, including the preservation of dispersed facies. Despite the relatively low sediment content of dispersed facies (~1.6% by volume), its thickness (up to 25 m) and ubiquity at Svfnafellsjokull results in a significant contribution to annual sediment discharge (1635-3270 m3 a"1) that is ~6.5 times that contributed by debris-rich stratified facies basal ice

Origin and significance of dispersed facies basal ice: Svínafellsjökull, Iceland

Dispersed facies basal ice – massive (i.e. structureless) ice with dispersed debris aggregates – is present at the margins of many glaciers and, as a product of internal glacial processes, has the potential to provide important information about the mechanisms of glacier flow and the nature of the subglacial environment. The origin of dispersed facies is poorly understood, with several hypotheses having been advanced for its formation, and there is disagreement as to whether it is largely a sedimentary or a tectonic feature. We test these established hypotheses at the temperate glacier Svínafellsjökull, Iceland, and find that none fully account for dispersed facies characteristics at this location. Instead, dispersed facies physical, sedimentological and stable-isotope (δ18O, δD) characteristics favour a predominantly tectonic origin that we suggest comprises the regelation and strain-induced metamorphism of debris-rich basal ice that has been entrained into an englacial position by tectonic processes operating at the base of an icefall. Further thickening of the resultant dispersed facies may also occur tectonically as a result of ice flow against the reverse bed slope of a terminal overdeepening. Lack of efficient subglacial drainage in the region of the overdeepening may limit basal melting and thus favour basal ice preservation, including the preservation of dispersed facies. Despite the relatively low sediment content of dispersed facies (∼1.6% by volume), its thickness (up to 25 m) and ubiquity at Svínafellsjökull results in a significant contribution to annual sediment discharge (1635–3270 m3 a−1) that is ∼6.5 times that contributed by debris-rich stratified facies basal ice

Origin and significance of dispersed facies basal ice: Svínafellsjökull, Iceland

Dispersed facies basal ice (massive ice with dispersed debris aggregates) outcrops at the margins of many ice masses and is important to glaciologists because of the information it provides about the nature of subglacial conditions and processes in the deep interior of glaciers and ice sheets. There has been little agreement, however, about how it forms with possible mechanisms including regelation and water flow through the intercrystalline vein network, strain-induced metamorphism of firnified glacier ice, shearing of basal debris-rich ice, freeze-on of subglacial water, and incorporation of surface debris into glacier ice. We test these established hypotheses at the temperate glacier Svínafellsjökull, southeast Iceland, and show that none fully account for dispersed facies characteristics here. From analysis of physical, sedimentological and stable isotope ( 18O and D) characteristics we suggest that dispersed facies forms from a combination of regelation and strain-induced metamorphism of debris-laden ice originally entrained by tectonic processes at the base of an icefall. We suggest that a terminal overdeepening may serve to further thicken dispersed facies as the glacier flows against a prominent reverse bedslope. There may also be a lack of subglacial drainage across the overdeepening which further allows dispersed facies to survive in thicknesses up to 20m despite the temperate location. Our results demonstrate that, despite its low sediment content ( 1.6%), the thick layer of dispersed facies contributes a higher annual sediment flux than other more debris-rich basal ice types. Hence dispersed facies and the processes that create it should not be overlooked in assessments of glacial sediment budgets

Feasibility Study Youth Work Funding Review: Phase 1, Feasibility Study Report

This report presents the findings from the first phase of a review of youth work funding in Wales carried out on behalf of the Welsh Government, Youth Engagement Branch (WGYEB). The work of the Interim Youth Work Board (IYWB) provides the background to this research. In 2018 the Board was tasked with developing recommendations aimed at achieving a sustainable delivery model for youth work in Wales, and these have provided the impetus for this research. The fourth of its 14 recommendations was to undertake an independent review into the sufficiency, transparency, accountability and effectiveness of funding and expenditure on youth work services across the Welsh Government, local authorities, and voluntary organisations, to assess the effective delivery of outcomes and impact for young people

Feasibility Study: Youth Work Funding Review Executive Summary

This report presents the findings from a feasibility study of a review of youth work funding in Wales carried out on behalf of the Welsh Government, Youth Engagement Branch (WGYEB). From 2018-2021 the Interim Youth Work Board (IYWB) was tasked with developing recommendations for a sustainable model for youth work in Wales. Their final report `Time to Deliver for young people in Wales’ provided the impetus for this research. The fourth of the Board’s 14 recommendations was that: “Welsh Government should […] undertake an independent review into the sufficiency, transparency, accountability, and effectiveness of funding and expenditure on youth work services across Welsh Government, local authorities, and voluntary organisations, to assess the effective delivery of outcomes and impact for young people” (Interim Youth Work Board, 2021)

Astudiaeth Ddichonoldeb Adolygiad o Ariannu Gwaith Ieuenctid Crynodeb Gweithredol

Mae’r adroddiad hwn yn cyflwyno canfyddiadau astudiaeth ddichonoldeb o adolygiad o gyllid gwaith ieuenctid yng Nghymru a gynhaliwyd ar ran Llywodraeth Cymru, y Gangen Ymgysylltu Ieuenctid (WGYEB). Rhwng 2018-2021 cafodd y Bwrdd Gwaith Ieuenctid Interim (BGII) y cyfrifoldeb o ddatblygu argymhellion ar gyfer model cynaliadwy ar gyfer gwaith ieuenctid yng Nghymru. Eu hadroddiad terfynol `Mae’n Bryd Cyflawni dros Bobl Ifanc yng Nghymru’ oedd y symbyliad ar gyfer yr ymchwil hwn. Dywed y pedwerydd o 14 argymhelliad y Bwrdd y: “Dylai Llywodraeth Cymru […] gynnal adolygiad annibynnol i ddigonolrwydd, tryloywder, atebolrwydd ac effeithiolrwydd cyllid a gwariant ar wasanaethau gwaith ieuenctid ar draws Llywodraeth Cymru, awdurdodau lleol a mudiadau gwirfoddol, er mwyn asesu sut y darparwyd deilliannau ac effaith ar gyfer pobl ifanc” (Bwrdd Gwaith Ieuenctid Interim, 2021)