Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV

Objectives: Lower pill burden leads to improved antiretroviral therapy (ART) adherence among HIV patients. Simpler dosing regimens have not been widely explored in real-world populations. We retrospectively assessed ART adherence, all-cause hospitalisation risk and costs, and other healthcare utilisation and costs in Medicaid enrollees with HIV treated with ART as a once-daily single-tablet regimen (STR) or two or more pills per day (2+PPD). Design: Patients with an HIV diagnosis from 2005 to 2009 receiving complete ART (ie, two nucleoside/nucleotide reverse transcriptase inhibitors plus a third agent) for ≥60 days as STR or 2+PPD were selected and followed until the first of (1) discontinuation of the complete ART, (2) loss of enrolment or (3) end of database. Adherence was measured using the medication possession ratio. Monthly all-cause healthcare utilisation and costs were observed from regimen initiation until follow-up end. Results: Of the 7381 patients who met inclusion criteria, 1797 were treated with STR and 5584 with 2+PPD. STR patients were significantly more likely to reach 95% adherence and had fewer hospitalisations than 2+PPD patients (both p<0.01). STR patients had mean (SD) total monthly costs of $2959 ($4962); 2+PPD patients had $3544 ($5811; p<0.001). Hospital costs accounted for 53.8% and pharmacy costs accounted for 32.5% of this difference. Multivariate analyses found that STR led to a 23% reduction in hospitalisations and a 17% reduction in overall healthcare costs. ART adherence appears to be a key mechanism mediating hospitalisation risk, as patients with ≥95% adherence (regardless of regimen type) had a lower hospitalisation rate compared with <95% adherence. Conclusions: While it was expected that STR patients would have lower pharmacy costs, we also found that STR patients had fewer hospitalisations and lower hospital costs than 2+PPD patients, resulting in significantly lower total healthcare costs for STR patients

PROCESSO HISTÓRICO DE OCUPAÇÃO DO MORRO SANTA TEREZINHA, EM FORTALEZA: RISCO AMBIENTAL VERSUS URBANIZAÇÃO

O crescimento urbano desordenado na cidade de Fortaleza contribuiu para o surgimento das áreas de risco ambiental. O presente artigo trata especificamente do Morro Santa Terezinha, localizado entre os bairros Vicente Pinzón e Cais do Porto e faz parte de uma das 89 áreas de risco da capital. O objetivo da pesquisa é avaliar a influência da urbanização para as ocorrências de desastres ambientais na localidade. A análise foi baseada em relatos de episódios coletados na hemeroteca do jornal O Povo e na Defesa Civil de Fortaleza. Verificou-se que as construções irregulares nas encostas do morro vinculadas aos períodos de chuvas intensas ocasionou o aumento dos riscos naturais na área. A partir desse resultado conclui-se que, as ocorrências de desastres ambientais naturais aumentaram à medida que a urbanização se expandiu afetando diretamente a população que reside na localidade

Assessing the impacts of the EU bioeconomy on third countries

To achieve its decarbonisation targets and boost the bioeconomy, the EU will inevitably consume more biomass. The EU’s own biomass resources will meet part of the demand although these ambitious targets will also require reliable and sustained access to third country suppliers. This ex-ante study assesses the potential impacts on land use changes, and associated GHG emissions, in Brazil resulting from increases in EU demand for ethanol to 2030, and draws evidence-based conclusions to verify the compliance of sugarcane feedstock production with the REDII environmental criteria. Land use changes due to expansion of the other main crops, including soybean, have also been calculated. Finally, the study points out that the difference between the country’s Nationally Determined Contribution (NDC) targets by 2030 (ca. 22 million CO2 tons) and our results is approximately an additional 900 million CO2 tons, which could put the country's contribution to Paris Agreement at risk.JRC.D.1-Bio-econom

Feasibility and acceptability of home delivery of water for dental caries control in latinx children — “sediento por una sonrisa,” thirsty for a smile : single-arm feasibility study

Background: Outcomes of surgical treatments under general anesthesia for early childhood caries of young children from low-income groups are poor requiring retreatment within 2 years. Dietary sugar is an ideal intervention target given that it is the most prominent risk factor for dental caries and there is increasing evidence of successful interventions to reduce its intake. Our aim is to investigate the feasibility and acceptability of the Thirsty for a Smile intervention, designed to promote consumption of water in lieu of sugar sweetened beverages, among children who underwent surgery for early childhood caries and their caregivers, mostly from Latino heritage. Methods: A single-arm feasibility study was conducted in a dental practice from a community health center in eastern Washington State. Bottled water was delivered to the participants’ homes and caregivers received patientcentered counseling for setting goals to increase children’s water intake and reduce sugar sweetened beverages consumption. We assessed the feasibility and acceptability of the intervention and study procedures through participation rates, interviews and a questionnaire completed by the caregivers. Data was analyzed and themes and descriptive statistics presented. Results: Twenty-two dyads of caregivers and their children between 2 and 9 years old who recently had surgical treatment for early childhood dental caries were enrolled. All study assessments were completed by more than 90% of participants, except for the final 24-h dietary recall (73%). Dietary counseling, both in person and brief telephone calls, was highly acceptable to the caregivers, and they also reported their children enjoyed and used the water bottles. On a scale from 1 to 10, the average rating for the helpfulness of the dietary counseling component for changing child’s drinking habits was 9.62 and for the water delivery component, 8.86. Conclusions: This study tested the feasibility of conducting a trial in a dental practice setting, and the acceptability among caregivers of young children who underwent surgery for early childhood caries. It demonstrated that the Thirsty for a Smile intervention and study processes were feasible and acceptable. The study provides useful information for implementation of a two-arm randomized controlled trial in this setting and may also benefit other researchers attempting to test similar interventions

AQUI JAZ UM RIO: IMPACTOS DO ESQUECIMENTO DO RIACHO PAJEÚ NA PAISAGEM URBANA DE FORTALEZA

O objetivo desse artigo é discutir o esquecimento do riacho Pajeú e o seu impacto na paisagem urbana de Fortaleza. Através de uma análise diacrônica, recorrendo às notícias veiculadas pelos principais jornais da cidade, no período de 1980 a 2019, situamos no tempo e no espaço significativos impactos relacionados ao esquecimento do riacho, que se refletem no cotidiano da cidade ao longo destes 39 anos. Concluímos, então, que, embora faça parte da paisagem de Fortaleza desde a sua fundação, o riacho encontra-se, atualmente, escondido sob essa mesma paisagem que ajudou a conformar, sofrendo os efeitos do esquecimento e sendo lembrado sobretudo quando repercute no espaço urbano como eventos de inundação

COVID-19 UK family carers and policy implications

Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad range of clinicians, researchers, and people with lived experience as informal carers to share their thoughts on the impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned as services closed. We focus on the carers of children and young people and adults and older adults with mental health diagnoses, and carers of people with intellectual disability or neurodevelopmental conditions across different care settings over the lifespan. We provide policy recommendations with the aim of improving outcomes for all carers

Impact of ultraviolet radiation on marine crustacean zooplankton and ichthyoplankton: a synthesis of results from the estuary and Gulf of St. Lawrence, Canada

The objectives of the research program reported upon here were (1) to measure ambient levels of UV radiation and determine whichvariables most strongly affected its attenuation in the waters of the estuary and Gulf of St. Lawrence, Canada; and (2) to investigate the potential direct impacts of W radiation on species of crustacean zooplankton and fish whose early life stages are planktonic. In this geographic region, productivity-determining biophysical interactions occur in the upper 0 to 30 m of the water column. Measurements of the diffuse attenuation coefficients for ultraviolet-B radiation (W-B, 280 to 320 nm) at various locations in this region indicated maximum 10% depths (the depth to which 10% of the surface energy penetrates at a given wavelength) of 3 to 4 m at a wavelength of 310 nm. Organisms residing in this layer-including the eggs and larvae of Calanus finmarchicus and Atlantic cod Gadus morhua-are exposed to biologically damaging levels of W radiation. As a result of these physical and biological characteristics, this system offered a relevant opportunity to assess the impacts of UV on subarctic marine ecosystems. Eggs of C. finmarchicus were incubated under the sun, with and without the W-B and/or UV-A (320 to 400 nm) wavebands. W-exposed eggs exhibited low percent hatchmg compared to those protected from W : W radiation had a strong negative impact on C. finmarchicus eggs. Further, percent hatching in W-B-exposed eggs was not significantly lower than that in eggs exposed to UV-A only: under natural sunlight, UV-A radiation appeared to be more detrimental to C. finmarchicus embryos than was UV-B. In analogous experiments with Atlantic cod eggs, exposure to UV-B produced a significant negative effect. However, UV-A had no negative effect on cod eggs. Additional experiments using a solar simulator (SS) revealed high wavelength-dependent mortality in both C. finmarchicus and cod embryos exposed to UV. The strongest effects occurred under exposures to wavelengths below 312 nm. At the shorter wavelengths (<305 nm) UV-B-induced mortality was strongly dose-dependent, but (for both C. finmarchicus and cod) not significantly influenced by dose-rate. Thus, at least within the limits of the exposures under which the biological weighting functions (BWFs) were generated, reciprocity held. The BWFs derived for UV-B-induced mortality in C. finmarchicus and cod eggs were similar in shape to the action spectrum for UV-B effects on naked DNA. Further, the wavelengthdependence of DNA damage was similar to that for the mortality effect. These observations suggest that W-induced mortality in C. finmarchicus and cod eggs is a direct result of DNA damage. There was no evidence of a detrimental effect of UV-A radiation in these SS-derived results. A mathematical model that includes the BWFs, vertical mixing of eggs, meteorological and hydrographic conditions, and ozone depletion, indicates that W-induced mortality in the C. finmarchicus egg population could be as high as 32.5 %, while the impact on the cod egg population was no more than 1.2%. Variability in cloud cover, water transparency (and the variables that affect it), and vertical distribution and displacement of planktonic organisms within the mixed layer can all have a greater effect on the flux of UV-B radiation to which they are exposed than will ozone layer depletion at these latitudes. Our observations indicate that C, finmarchicus and cod eggs present in the first meter of the water column (likely only a small percentage of the total egg populations) are susceptible to W radiation. However, although exposure to UV can negatively impact crustacean zooplankton and ichthyoplankton populations, these direct effects are likely minimal within the context of all the other environmental factors that produce the very high levels of mortality typically observed in their planktonic early life stages. The impact of indnect effects-which may well be of much greater import-has yet to be evaluated

Characterization of FOXSI Sounding Rocket Hard X-Ray Detectors Using Advanced Light Source at Berkeley

No abstract availabl

On the faintest solar coronal hard X-rays observed with FOXSI

Solar nanoflares are small eruptive events releasing magnetic energy in the quiet corona. If nanoflares follow the same physics as their larger counterparts, they should emit hard X-rays (HXRs) but with a rather faint intensity. A copious and continuous presence of nanoflares would deliver enormous amounts of energy into the solar corona, possibly accounting for its high temperatures. To date, there has not been any direct observation of such sustained and persistent HXRs from the quiescent Sun. However, Hannah et al. in 2010 constrained the quiet Sun HXR emission using almost 12 days of quiescent solar-off-pointing observations by RHESSI. These observations set upper limits at $3.4\times 10^{-2}$ photons$^{-1}$ s$^{-1}$ cm$^{-2}$ keV$^{-1}$ and $9.5\times 10^{-4}$ photons$^{-1}$ s$^{-1}$ cm$^{-2}$ keV$^{-1}$ for the 3-6 keV and 6-12 keV energy ranges, respectively. Observing feeble HXRs is challenging because it demands high sensitivity and dynamic range instruments in HXRs. The Focusing Optics X-ray Solar Imager (FOXSI) sounding rocket experiment excels in these two attributes. Particularly, FOXSI completed its third successful flight (FOXSI-3) on September 7th, 2018. During FOXSI-3's flight, the Sun exhibited a fairly quiet configuration, displaying only one aged non-flaring active region. Using the entire $\sim$6.5 minutes of FOXSI-3 data, we constrained the quiet Sun emission in HXRs. We found $2\sigma$ upper limits in the order of $\sim 10^{-3}$ photons$^{-1}$ s$^{-1}$ cm$^{-2}$ keV$^{-1}$ for the 5-10 keV energy range. FOXSI-3's upper limit is consistent with what was reported by Hannah et al., 2010, but FOXSI-3 achieved this result using $\sim$1/2640 less time than RHESSI. A possible future spacecraft using FOXSI's concept would allow enough observation time to constrain the current HXR quiet Sun limits further or perhaps even make direct detections