Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya.

HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32-5.56), HIV education (aOR 3.28, 95% CI 1.92-6.83), and wait time (aOR 1.97 95% CI 1.03-3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06-3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33-8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction

Spectroscopic and Computational Investigation of Low-Spin MnIII Bis(scorpionate) Complexes

Six-coordinate MnIII complexes are typically high-spin (S = 2), however, the scorpionate ligand, both in its traditional, hydridotris(pyrazolyl)borate form, Tp– and Tp*– (the latter with 3,5-dimethylpyrazole substituents) and in an aryltris(carbene)borate (i.e., N-heterocyclic carbene, NHC) form, [Ph(MeIm)3B]–, (MeIm = 3-methylimidazole) lead to formation of bis(scorpionate) complexes of MnIII with spin triplet ground states; three of which were investigated herein: [Tp2Mn]SbF6 (1SbF6), [Tp*2Mn]SbF6 (2SbF6), and [{Ph(MeIm)3B}2Mn]CF3SO3 (3CF3SO3). These trigonally symmetric complexes were studied experimentally by magnetic circular dichroism (MCD) spectroscopy (the propensity of 3 to oxidize to MnIV precluded collection of useful MCD data) including variable temperatures and fields (VTVH-MCD) and computationally by ab initio CASSCF/NEVPT2 methods. These combined experimental and theoretical techniques establish the 3A2g electronic ground state for the three complexes, and provide information on the energy of the “conventional” high-spin excited state (5Eg) and other, triplet excited states. These results show the electronic effect of pyrazole ring substituents in comparing 1 and 2. The tunability of the scorpionate ligand, even by perhaps the simplest change (from pyrazole in 1 to 3,5-dimethylpyrazole in 2) is quantitatively manifested through perturbations in ligand-field excited-state energies that impact ground-state zero-field splittings. The comparison with the NHC donor is much more dramatic. In 3, the stronger σ-donor properties of the NHC lead to a quantitatively different electronic structure, so that the lowest lying spin triplet excited state, 3Eg, is much closer in energy to the ground state than in 1 or 2. The zero-field splitting (zfs) parameters of the three complexes were calculated and in the case of 1 and 2 compare closely to experiment (lower by < 10 %, < 2 cm–1 in absolute terms); for 3 the large magnitude zfs is reproduced, although there is ambiguity about its sign. The comprehensive picture obtained for these bis(scorpionate) MnIII complexes provides quantitative insight into the role played by the scorpionate ligand in stabilizing unusual electronic structures

Cadherin-26 (CDH26) regulates airway epithelial cell cytoskeletal structure and polarity.

Polarization of the airway epithelial cells (AECs) in the airway lumen is critical to the proper function of the mucociliary escalator and maintenance of lung health, but the cellular requirements for polarization of AECs are poorly understood. Using human AECs and cell lines, we demonstrate that cadherin-26 (CDH26) is abundantly expressed in differentiated AECs, localizes to the cell apices near ciliary membranes, and has functional cadherin domains with homotypic binding. We find a unique and non-redundant role for CDH26, previously uncharacterized in AECs, in regulation of cell-cell contact and cell integrity through maintaining cytoskeletal structures. Overexpression of CDH26 in cells with a fibroblastoid phenotype increases contact inhibition and promotes monolayer formation and cortical actin structures. CDH26 expression is also important for localization of planar cell polarity proteins. Knockdown of CDH26 in AECs results in loss of cortical actin and disruption of CRB3 and other proteins associated with apical polarity. Together, our findings uncover previously unrecognized functions for CDH26 in the maintenance of actin cytoskeleton and apicobasal polarity of AECs

Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital:an observational case control study

BACKGROUND: Older people are commonly prescribed multiple medications, including medications with anticholinergic effects. Polypharmacy and anticholinergic medications may be risk factors for the development of delirium. METHODS: Patients from a medical admission unit who were over 70, with DSM-IV diagnosed delirium and patients without delirium, were investigated. Number of drugs prescribed on admission and anticholinergic burden using two scales (the Anticholinergic Cognitive Burden Scale [ACB] and the Anticholinergic Drug Scale [ADS]) were recorded from electronic prescribing records. The relationship and predictive ability of these were explored. RESULTS: The sample included 125 patients with DSM-IV diagnosed delirium and 122 patients without delirium. The mean age of the sample was 84.0 years. The median number of drugs prescribed was 7: 79.8 % were prescribed ≥5 drugs and 29.0 % ≥10 drugs. The median ACB score was 1 and the median ADS score was 1.5. 73.4 % of patients had an ACB score of ≥1 and 73.0 % had a ADS score ≥1. There was no association between: number of drugs prescribed, rate of polypharmacy, rate of excessive polypharmacy, ACB score and ADS score, and a diagnosis of delirium on admission. Only acetylcholinesterase inhibitor use predicted delirium (OR 3.86, p = 0.04) and the number of drugs prescribed was negatively correlated with age (spearman rho = −0.18, p = 0.006). CONCLUSION: Neither number of drugs prescribed, polypharmacy or anticholinergic burden were associated with delirium on admission, questioning the clinical usefulness of anticholinergic drug scales. Further research is needed to unpick fully the relationship between, drugs, anticholinergic burden, age, and prevalent delirium in older patients and whether there is any role for these scales in clinical practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12877-016-0336-9) contains supplementary material, which is available to authorized users

Project Vestia: Future of Martian Habitats

Project Vestia’s main goal is to design and test a floor for inflatable habitat modules (IHM) in Martian or Lunar environments. Currently, there is no method for creating a stable floor in an IHM that does not inhibit the benefits of using that module, as there is for a hard shell habitat. The scope of this project is to: design and simulate three designs; manufacture and test scale models of the top two performing models; design, manufacture, and test different hinge constructions. Each final scale model must withstand 1668.2 N of downwardly applied force, a scaled down representation of what could be typical use modified to account for difference in gravitational pull. Three folding designs were created with Fusion 360 computer modeling software, and simulation was performed using ANSYS software. The hinges used in each model are all of one design but multiple different construction methods. Hinges were manufactured using each method, and then were subsequently tested to determine each method’s tensile strength and flexibility. The parts are all manufactured and tested by the student researchers in house, with materials obtained externally. Preliminary results show that with current design methodology, all models have a minimum factor of safety of 1.5 at the weakest point, compared to at least 5 across the rest of each design. The end goal of this project is to confirm a design and create a scale model of the best design with the best hinge construction method and publish the findings to encourage further research and apply this technology in future IHMs

Can spatial statistical river temperature models be transferred between catchments?

There has been increasing use of spatial statistical models to understand and predict river temperature (Tw) from landscape covariates. However, it is not financially or logistically feasible to monitor all rivers and the transferability of such models has not been explored. This paper uses Tw data from four river catchments collected in August 2015 to assess how well spatial regression models predict the maximum 7-day rolling mean of daily maximum Tw (Twmax) within and between catchments. Models were fitted for each catchment separately using (1) landscape covariates only (LS models) and (2) landscape covariates and an air temperature (Ta) metric (LS_Ta models). All the LS models included upstream catchment area and three included a river network smoother (RNS) that accounted for unexplained spatial structure. The LS models transferred reasonably to other catchments, at least when predicting relative levels of Twmax. However, the predictions were biased when mean Twmax differed between catchments. The RNS was needed to characterise and predict finer-scale spatially correlated variation. Because the RNS was unique to each catchment and thus non-transferable, predictions were better within catchments than between catchments. A single model fitted to all catchments found no interactions between the landscape covariates and catchment, suggesting that the landscape relationships were transferable. The LS_Ta models transferred less well, with particularly poor performance when the relationship with the Ta metric was physically implausible or required extrapolation outside the range of the data. A single model fitted to all catchments found catchment-specific relationships between Twmax and the Ta metric, indicating that the Ta metric was not transferable. These findings improve our understanding of the transferability of spatial statistical river temperature models and provide a foundation for developing new approaches for predicting Tw at unmonitored locations across multiple catchments and larger spatial scales

Future evolution and uncertainty of river flow regime change in a deglaciating river basin

The flow regimes of glacier-fed rivers are sensitive to climate change due to strong climate–cryosphere–hydrosphere interactions. Previous modelling studies have projected changes in annual and seasonal flow magnitude but neglect other changes in river flow regime that also have socio-economic and environmental impacts. This study employs a signature-based analysis of climate change impacts on the river flow regime for the deglaciating Virkisá river basin in southern Iceland. Twenty-five metrics (signatures) are derived from 21st century projections of river flow time series to evaluate changes in different characteristics (magnitude, timing and variability) of river flow regime over sub-daily to decadal timescales. The projections are produced by a model chain that links numerical models of climate and glacio-hydrology. Five components of the model chain are perturbed to represent their uncertainty including the emission scenario, numerical climate model, downscaling procedure, snow/ice melt model and runoff-routing model. The results show that the magnitude, timing and variability of glacier-fed river flows over a range of timescales will change in response to climate change. For most signatures there is high confidence in the direction of change, but the magnitude is uncertain. A decomposition of the projection uncertainties using analysis of variance (ANOVA) shows that all five perturbed model chain components contribute to projection uncertainty, but their relative contributions vary across the signatures of river flow. For example, the numerical climate model is the dominant source of uncertainty for projections of high-magnitude, quick-release flows, while the runoff-routing model is most important for signatures related to low-magnitude, slow-release flows. The emission scenario dominates mean monthly flow projection uncertainty, but during the transition from the cold to melt season (April and May) the snow/ice melt model contributes up to 23&thinsp;% of projection uncertainty. Signature-based decompositions of projection uncertainty can be used to better design impact studies to provide more robust projections.</p

COPI mediates recycling of an exocytic SNARE by recognition of a ubiquitin sorting signal

The COPI coat forms transport vesicles from the Golgi complex and plays a poorly defined role in endocytic trafficking. Here we show that COPI binds K63-linked polyubiquitin and this interaction is crucial for trafficking of a ubiquitinated yeast SNARE (Snc1). Snc1 is a v-SNARE that drives fusion of exocytic vesicles with the plasma membrane, and then recycles through the endocytic pathway to the Golgi for reuse in exocytosis. Removal of ubiquitin from Snc1, or deletion of a β’-COP subunit propeller domain that binds K63-linked polyubiquitin, disrupts Snc1 recycling causing aberrant accumulation in internal compartments. Moreover, replacement of the β’-COP propeller domain with unrelated ubiquitin-binding domains restores Snc1 recycling. These results indicate that ubiquitination, a modification well known to target membrane proteins to the lysosome or vacuole for degradation, can also function as recycling signal to sort a SNARE into COPI vesicles in a non-degradative pathway