Consequences of a changing US strategy in the global HIV investment landscape.

OBJECTIVE: The global fight against HIV/AIDS in Africa has long been a focus of US foreign policy, but this could change if the federal budget for 2018 proposed by the US Office of Management and Budget is adopted. We aim to inform public and Congressional debate around this issue by evaluating the historical and potential future impact of US investment in the African HIV response. DESIGN/METHODS: We use a previously published mathematical model of HIV transmission to characterize the possible impact of a series of financial scenarios for the historical and future AIDS response across Sub-Saharan Africa. RESULTS: We find that US funding has saved nearly five million adults in Sub-Saharan Africa from AIDS-related deaths. In the coming 15 years, if current numbers on antiretroviral treatment are maintained without further expansion of programs (the proposed US strategy), nearly 26 million new HIV infections and 4.4 million AIDS deaths may occur. A 10% increase in US funding, together with ambitious domestic spending and focused attention on optimizing resources, can avert up to 22 million HIV infections and save 2.3 million lives in Sub-Saharan Africa compared with the proposed strategy. CONCLUSION: Our synthesis of available evidence shows that the United States has played, and could continue to play, a vital role in the global HIV response. Reduced investment could allow more than two million avoidable AIDS deaths by 2032, whereas continued leadership by the United States and other countries could bring UNAIDS targets for ending the epidemic into reach

Rising obesity-related hospital admissions among children and young people in England: national time trends study

Objective: To describe the trends in hospital admissions associated with obesity as a primary diagnosis and comorbidity, and bariatric surgery procedures among children and young people in England. Design: National time trends study of hospital admissions data between 2000 and 2009. Participants: Children and young people aged 5 to 19 years who were admitted to hospital with any diagnosis of obesity. Main outcome measures: Age- and sex-specific admission rates per million children. Results: Between 2000 and 2009, age- and sex-specific hospital admission rates in 5–19 year olds for total obesity-related diagnoses increased more than four-fold from 93.0 (95% CI 86.0 to 100.0) per million children to 414.0 (95% CI 410.7 to 417.5) per million children, largely due to rising admissions where obesity was mentioned as a co-morbidity. The median age of admission to hospital over the study period was 14.0 years; 5,566 (26.7%) admissions were for obesity and 15,319 (73.3%) mentioned obesity as a comorbidity. Admissions were more common in girls than boys (56.2% v 43.8%). The most common reasons for admission where obesity was a comorbid condition were sleep apnoea, asthma, and complications of pregnancy. The number of bariatric surgery procedures has risen from 1 per year in 2000 to 31 in 2009, with the majority were performed in obese girls (75.6%) aged 13–19 years. Conclusions: Hospital admission rates for obesity and related comorbid conditions have increased more than four-fold over the past decade amongst children and young people. Although some of the increase is likely to be due to improved case ascertainment, conditions associated with obesity in children and young people are imposing greater challenges for health care providers in English hospitals. Most inpatient care is directed at dealing with associated conditions rather than primary assessment and management of obesity itself

Impact of Pay for Performance on Ethnic Disparities in Intermediate Outcomes for Diabetes: A Longitudinal Study

OBJECTIVE—The purpose of this study was to examine the impact of a major pay for performance incentive on trends in the quality of diabetes care in white, black, and South Asian ethnic groups in an urban setting in the U.K

Uniaxial compression of single crystal and polycrystalline tantalum

A series of compression experiments characterising the elastic-plastic response of single crystal and polycrystalline tantalum from quasi-static to intermediate strain-rates (10^−3 – 10^3 s−1) over a range of temperatures (233–438 K) are reported in this paper. The single crystal experiments show significant differences in the response of the three principle crystal orientations of tantalum in terms of yield, work hardening and ultimate deformed shapes. Modelling is undertaken using a dislocation mechanics based crystal plasticity finite element model giving insight into the underlying microscopic processes that govern the macroscopic response. The simulations show the importance of the dislocation mobility relations and laws governing the evolution of the mobile dislocation density for capturing the correct behaviours. The inclusion of the twinning/anti-twinning asymmetry is found to influence [100] orientation most strongly, and is shown to be critical for matching the relative yield strengths. In general the simulations are able to adequately match experimental trends although some specific details such as exact strain hardening evolution are not reproduced suggesting a more complex hardening model is required. 3D finite element simulations approximating the tests are also undertaken and are able to predict the final deformed sample shapes well once the twinning/anti-twinning asymmetry is included (particularly for the [100] orientation). The polycrystalline data in both as-received and cold rolled conditions shows the initial yield strength is highest and work hardening rate is lowest for the cold-rolled material due to the increase in mobile dislocation density caused by the prior work. The general behavioural trends with temperature and strain-rate of the polycrystalline materials are reproduced in the single crystal data however the specific form of stress versus strain curves are significantly different. This is discussed in terms of the similar active slip systems in polycrystalline material to high symmetry single crystals but with the significant added effect of grain boundary interactions

A cluster randomized controlled trial of the effectiveness and cost-effectiveness of Intermediate Care Clinics for Diabetes (ICCD) : study protocol for a randomized controlled trial

Background World-wide healthcare systems are faced with an epidemic of type 2 diabetes. In the United Kingdom, clinical care is primarily provided by general practitioners (GPs) rather than hospital specialists. Intermediate care clinics for diabetes (ICCD) potentially provide a model for supporting GPs in their care of people with poorly controlled type 2 diabetes and in their management of cardiovascular risk factors. This study aims to (1) compare patients with type 2 diabetes registered with practices that have access to an ICCD service with those that have access only to usual hospital care; (2) assess the cost-effectiveness of the intervention; and (3) explore the views and experiences of patients, health professionals and other stakeholders. Methods/Design This two-arm cluster randomized controlled trial (with integral economic evaluation and qualitative study) is set in general practices in three UK Primary Care Trusts. Practices are randomized to one of two groups with patients referred to either an ICCD (intervention) or to hospital care (control). Intervention group: GP practices in the intervention arm have the opportunity to refer patients to an ICCD - a multidisciplinary team led by a specialist nurse and a diabetologist. Patients are reviewed and managed in the ICCD for a short period with a goal of improving diabetes and cardiovascular risk factor control and are then referred back to practice. or Control group: Standard GP care, with referral to secondary care as required, but no access to ICCD. Participants are adults aged 18 years or older who have type 2 diabetes that is difficult for their GPs to control. The primary outcome is the proportion of participants reaching three risk factor targets: HbA1c (≤7.0%); blood pressure (<140/80); and cholesterol (<4 mmol/l), at the end of the 18-month intervention period. The main secondary outcomes are the proportion of participants reaching individual risk factor targets and the overall 10-year risks for coronary heart disease(CHD) and stroke assessed by the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Other secondary outcomes include body mass index and waist circumference, use of medication, reported smoking, emotional adjustment, patient satisfaction and views on continuity, costs and health related quality of life. We aimed to randomize 50 practices and recruit 2,555 patients

Representing addition and subtraction : learning the formal conventions

The study was designed to test the effects of a structured intervention in teaching children to represent addition and subtraction. In a post-test only control group design, 90 five-year-olds experienced the intervention entitled Bi-directional Translation whilst 90 control subjects experienced typical teaching. Post-intervention testing showed some significant differences between the two groups both in terms of being able to effect the addition and subtraction operations and in being able to determine which operation was appropriate. The results suggest that, contrary to historical practices, children's exploration of real world situations should precede practice in arithmetical symbol manipulation

Women, know your limits: Cultural sexism in academia

Despite the considerable advances of the feminist movement across Western societies, in Universities women are less likely to be promoted, or paid as much as their male colleagues, or even get jobs in the first place. One way in which we can start to reflect on why this might be the case is through hearing the experiences of women academics themselves. Using feminist methodology, this article attempts to unpack and explore just some examples of ‘cultural sexism’ which characterise the working lives of many women in British academia.This article uses qualitative methods to describe and make sense of just some of those experiences. In so doing, the argument is also made that the activity of academia is profoundly gendered and this explicit acknowledgement may contribute to our understanding of the under-representation of women in senior positions

Environmental differences between sites control the diet and nutrition of the carnivorous plant Drosera rotundifolia

Background and aims: Carnivorous plants are sensitive to small changes in resource availability, but few previous studies have examined how differences in nutrient and prey availability affect investment in and the benefit of carnivory. We studied the impact of site-level differences in resource availability on ecophysiological traits of carnivory for Drosera rotundifolia L. Methods: We measured prey availability, investment in carnivory (leaf stickiness), prey capture and diet of plants growing in two bogs with differences in N deposition and plant available N: Cors Fochno (0.62 g m−2 yr.−1, 353 μg l−1), Whixall Moss (1.37 g m−2 yr.−1, 1505 μg l−1). The total N amount per plant and the contributions of prey/root N to the plants’ N budget were calculated using a single isotope natural abundance method. Results: Plants at Whixall Moss invested less in carnivory, were less likely to capture prey, and were less reliant on prey-derived N (25.5% compared with 49.4%). Actual prey capture did not differ between sites. Diet composition differed – Cors Fochno plants captured 62% greater proportions of Diptera. Conclusions: Our results show site-level differences in plant diet and nutrition consistent with differences in resource availability. Similarity in actual prey capture may be explained by differences in leaf stickiness and prey abundance

INVESTIGATING THE RELATIONSHIP BETWEEN MOVEMENT VARIABILITY, SKILL ACQUISITION AND ADAPTABILITY

Facilitating adaptability is a role attributed to movement variability. The aim of this investigation was to track changes in movement variability during the learning of a novel task where adaptability was expected to be present. A contextual interference design was implemented with sample entropy and vector coding used to quantify joint and coordination variability respectively. Those exposed to high contextual interference were significantly better performed and more adaptable. Significant decreases in coordination variability were found during the learning process for all participants. The more adaptable group also exhibited higher coordination variability at key points providing some support for previous hypotheses on the interaction between, skill acquisition and adaptability. Results have implications for practitioners working in skill acquisition