Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa

Introduction: We aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 treatment-as-prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. Methods: Individuals ]16 years were offered HBHCT; those who were identified HIV positive were referred to cluster-based TasP clinics and offered antiretroviral treatment (ART) immediately (five clusters) or according to national guidelines (five clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm. Results: Overall, 1323 HIV-positive adults (72.9% women) not in HIV care at referral were included, of whom 36.9% (n488) linked to care B3 months of referral (similar by sex). In adjusted analyses (n1222), individuals who had never been in HIV care before referral were significantly less likely to link to care than those who had previously been in care (B33% vs. 42%, pB0.001). Linkage to care was lower in students (adjusted odds-ratio [aOR] 0.47; 95% confidence interval [CI] 0.240.92) than in employed adults, in adults who completed secondary school (aOR0.68; CI 0.490.96) or at least some secondary school (aOR0.59; CI 0.410.84) versus 5 primary school, in those who lived at 1 to 2 km (aOR0.58; CI 0.440.78) or 25 km from the nearest TasP clinic (aOR0.57; CI 0.410.77) versus B1 km, and in those who were referred to clinic after ]2 contacts (aOR0.75; CI 0.580.97) versus those referred at the first contact. Linkage to care was higher in adults who reported knowing an HIV-positive family member (aOR1.45; CI 1.121.86) versus not, and in those who said that they would take ART as soon as possible if they were diagnosed HIV positive (aOR2.16; CI 1.134.10) versus not. Conclusions: Fewer than 40% of HIV-positive adults not in care at referral were linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal test and treat coverage will require innovative interventions to support linkage to HIV care

A mixed methods feasibility study to evaluate the use of a low-intensity, nurse-delivered cognitive behavioural therapy for the treatment of irritable bowel syndrome

Introduction: Irritable bowel syndrome (IBS) is characterised by symptoms such as abdominal pain, constipation, diarrhoea and bloating. These symptoms impact on health-related quality of life, result in excess service utilisation and are a significant burden to healthcare systems. Certain mechanisms which underpin IBS can be explained by a biopsychosocial model which is amenable to psychological treatment using techniques such as cognitive behavioural therapy (CBT). While current evidence supports CBT interventions for this group of patients, access to these treatments within the UK healthcare system remains problematic. Methods and analysis: A mixed methods feasibility randomised controlled trial will be used to assess the feasibility of a low-intensity, nurse-delivered guided self-help intervention within secondary care gastrointestinal clinics. A total of 60 participants will be allocated across four treatment conditions consisting of: high-intensity CBT delivered by a fully qualified cognitive behavioural therapist, low-intensity guided self-help delivered by a registered nurse, self-help only without therapist support and a treatment as usual control condition. Participants from each of the intervention arms of the study will be interviewed in order to identify potential barriers and facilitators to the implementation of CBT interventions within clinical practice settings. Quantitative data will be analysed using descriptive statistics only. Qualitative data will be analysed using a group thematic analysis.N/

Tectonic evolution of the Rehamna metamorphic dome (Morocco) in the context of the Alleghanian-Variscan orogeny

Structural and 40Ar/39Ar geochronological investigations of the Rehamna Massif (Meseta, Moroccan Variscan belt) provide new constraints on the tectonic evolution of the Alleghanian-Variscan orogen during the Upper Paleozoic. Three main tectonic events have been recognized: (1) Southward thrusting of an Ordovician sequence over the Proterozoic basement, its Cambrian sedimentary cover, and the overlying Devono-Carboniferous basin. This event caused subhorizontal shearing and prograde Barrovian metamorphism of the buried rocks. (2) Continuous shortening resulting in the development of a synconvergent extrusion of metamorphosed units to form a dome elongated E-W. This was responsible for synconvergent detachment of the Ordovician upper crustal sequence. The timing of these two episodes is constrained to 310–295 Ma by cooling and metamorphic amphibole and mica ages (3) A NW-WNW convergence in a direction orthogonal to the previous one and characterized by the accretion of the Rehamna dome to the continental basement in the east. Based on 40Ar/39Ar cooling ages from a syntectonic granitoid and its host rocks and metamorphic 40Ar/39Ar ages from greenschist facies mylonite, the timing of this event falls between 295 and 280 Ma. The end of the Variscan orogeny in the Moroccan Meseta is constrained by the 40Ar/39Ar cooling age of a posttectonic pluton dated at ~275 Ma. The tectonic events highlighted in Morocco coincide with the late Variscan-Alleghanian tectonic evolution of southern Europe and North America and can be correlated with the global reorganization of plates that accompanied suturing of Pangaea at around 295 Ma.Peer reviewe

SIGMORPHON 2021 Shared Task on Morphological Reinflection: Generalization Across Languages

This year's iteration of the SIGMORPHON Shared Task on morphological reinflection focuses on typological diversity and cross-lingual variation of morphosyntactic features. In terms of the task, we enrich UniMorph with new data for 32 languages from 13 language families, with most of them being under-resourced: Kunwinjku, Classical Syriac, Arabic (Modern Standard, Egyptian, Gulf), Hebrew, Amharic, Aymara, Magahi, Braj, Kurdish (Central, Northern, Southern), Polish, Karelian, Livvi, Ludic, Veps, Võro, Evenki, Xibe, Tuvan, Sakha, Turkish, Indonesian, Kodi, Seneca, Asháninka, Yanesha, Chukchi, Itelmen, Eibela. We evaluate six systems on the new data and conduct an extensive error analysis of the systems' predictions. Transformer-based models generally demonstrate superior performance on the majority of languages, achieving >90% accuracy on 65% of them. The languages on which systems yielded low accuracy are mainly under-resourced, with a limited amount of data. Most errors made by the systems are due to allomorphy, honorificity, and form variation. In addition, we observe that systems especially struggle to inflect multiword lemmas. The systems also produce misspelled forms or end up in repetitive loops (e.g., RNN-based models). Finally, we report a large drop in systems' performance on previously unseen lemmas.Peer reviewe

Gamma-Linolenic and Stearidonic Acids Are Required for Basal Immunity in Caenorhabditis elegans through Their Effects on p38 MAP Kinase Activity

Polyunsaturated fatty acids (PUFAs) form a class of essential micronutrients that play a vital role in development, cardiovascular health, and immunity. The influence of lipids on the immune response is both complex and diverse, with multiple studies pointing to the beneficial effects of long-chain fatty acids in immunity. However, the mechanisms through which PUFAs modulate innate immunity and the effects of PUFA deficiencies on innate immune functions remain to be clarified. Using the Caenorhabditis elegans–Pseudomonas aeruginosa host–pathogen system, we present genetic evidence that a Δ6-desaturase FAT-3, through its two 18-carbon products—gamma-linolenic acid (GLA, 18:3n6) and stearidonic acid (SDA, 18:4n3), but not the 20-carbon PUFAs arachidonic acid (AA, 20:4n6) and eicosapentaenoic acid (EPA, 20:5n3)—is required for basal innate immunity in vivo. Deficiencies in GLA and SDA result in increased susceptibility to bacterial infection, which is associated with reduced basal expression of a number of immune-specific genes—including spp-1, lys-7, and lys-2—that encode antimicrobial peptides. GLA and SDA are required to maintain basal activity of the p38 MAP kinase pathway, which plays important roles in protecting metazoan animals from infections and oxidative stress. Transcriptional and functional analyses of fat-3–regulated genes revealed that fat-3 is required in the intestine to regulate the expression of infection- and stress-response genes, and that distinct sets of genes are specifically required for immune function and oxidative stress response. Our study thus uncovers a mechanism by which these 18-carbon PUFAs affect basal innate immune function and, consequently, the ability of an organism to defend itself against bacterial infections. The conservation of p38 MAP kinase signaling in both stress and immune responses further encourages exploring the function of GLA and SDA in humans

UniMorph 4.0:Universal Morphology

The Universal Morphology (UniMorph) project is a collaborative effort providing broad-coverage instantiated normalized morphological inflection tables for hundreds of diverse world languages. The project comprises two major thrusts: a language-independent feature schema for rich morphological annotation and a type-level resource of annotated data in diverse languages realizing that schema. This paper presents the expansions and improvements made on several fronts over the last couple of years (since McCarthy et al. (2020)). Collaborative efforts by numerous linguists have added 67 new languages, including 30 endangered languages. We have implemented several improvements to the extraction pipeline to tackle some issues, e.g. missing gender and macron information. We have also amended the schema to use a hierarchical structure that is needed for morphological phenomena like multiple-argument agreement and case stacking, while adding some missing morphological features to make the schema more inclusive. In light of the last UniMorph release, we also augmented the database with morpheme segmentation for 16 languages. Lastly, this new release makes a push towards inclusion of derivational morphology in UniMorph by enriching the data and annotation schema with instances representing derivational processes from MorphyNet

Invasion success of a widespread invasive predator may be explained by a high predatory efficacy but may be influenced by pathogen infection

Invasive alien species (IAS) can drive community change through ecological interactions. Parasites and pathogens can play an important role in community function including mitigating or enhancing IAS impacts. Despite this, the degree to which pathogen pressure influences IAS impacts remains poorly understood. We quantified the predatory behaviour of the highly invasive alien harlequin ladybird (Harmonia axyridis) and two UK native species, the 7-spot (Coccinella septempunctata) and 2-spot (Adalia bipunctata) ladybirds, using comparative functional response experiments. We investigated the impacts of pathogen infection on the predatory ability of the ladybirds by exposing individuals to Beauveria bassiana, a widespread entomopathogen. Invasive H. axyridis was a more efficient predator than both the native A. bipunctata and C. septempunctata, often having higher attack and/or lower prey handling time coefficients, whereas native A. bipunctata were the least efficient predators. These differences were found in both adult and larval life-stages. Beauveria bassiana infection significantly altered the predatory efficiency of adult and larval ladybird predators. The effects of pathogenic infection differed between species and life-stage but in many cases infection resulted in a reduced predatory ability. We suggest that the interactions between IAS and pathogens are integral to determining invasion success and impact