Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa.

This version is the Accepted Manuscript, and was published in final edited form as: J Acquir Immune Defic Syndr. 2017 April 01; 74(4): 383–389. doi:10.1097/QAI.0000000000001284OBJECTIVE: Retention in HIV care, particularly among postpartum women, is a challenge to national antiretroviral therapy programs. Retention estimates may be underestimated because of unreported transfers. We explored mobility and clinic switching among patients considered lost to follow-up (LTFU). DESIGN: Observational cohort study. METHODS: Of 788 women initiating antiretroviral therapy during pregnancy at 6 public clinics in Johannesburg, South Africa, 300 (38.1%) were LTFU (no visit ≥3 months). We manually searched for these women in the South African National Health Laboratory Services database to assess continuity of HIV care. We used geographic information system tools to map mobility to new facilities. RESULTS: Over one-third (37.6%) of women showed evidence of continued HIV care after LTFU. Of these, 67.0% continued care in the same province as the origin clinic. Compared with those who traveled outside of the province for care, these same-province "clinic shoppers" stayed out-of-care longer {median 373 days [interquartile range (IQR): 175-790] vs. 175.5 days (IQR: 74-371)} and had a lower CD4 cell count on re-entry [median 327 cells/μL (IQR: 196-576) vs. 493 cells/μL (IQR: 213-557). When considering all women with additional evidence of care as engaged in care, cohort LTFU dropped from 38.1% to 25.0%. CONCLUSION: We found evidence of continued care after LTFU and identified local and national clinic mobility among postpartum women. Laboratory records do not show all clinic visits and manual matching may have been under- or overestimated. A national health database linked to a unique identifier is necessary to improve reporting and patient care among highly mobile populations

Learning technology in Scottish higher education ‐ a survey of the views of senior managers, academic staff and ‘experts’

As part of an evaluation of the Scottish Learning Technology Dissemination Initiative (LTDI), a survey was conducted of the views of academic staff, members of computer‐assisted learning and staff development units, and senior managers in all Scottish higher education institutions (HEIs). Most respondents across all subject areas and types of institutions (including those who rated themselves as less experienced with use of C&IT in teaching than their colleagues) believed that learning technology (LT) had moderate to very high potential for improving the way in which students learn. Awareness of the various agencies which have been established to promote its use in HEIs was very high, with few staff being unaware of any of them. Senior staff largely agreed that the value of these approaches lay in the improvement or maintenance of quality rather than in creating efficiency gains. Whilst there was a mostly positive view of the value of learning technology there are still significant barriers to its uptake by staff, the most important being lack of time, infrastructure, software and training, plus a failure (perceived or actual) of institutions to value teaching. The rather pessimistic view of ‘experts’ of the willingness of their less committed colleagues to make use of learning technology contrasted with the generally positive responses obtained from a broad group of 1,000 academic staff on their awareness of and attitudes to it. An analysis of the SHEFC's Teaching Quality Assessment reports during 1992–6 revealed substantial variability between and within subject assessments as to whether specific comments were made about IT provision and its use in learning and teaching

The influence of life experiences on the development of resilience in older people with co-morbid health problems.

Background: Co-morbidity is a major late-life challenge with poor outcomes, yet many older people are resilient. We consider an ecopsychosocial framework of resilience to investigate this disparity. This theorises that sources of resilience may be personal, social and structural. We explored older people’s responses and reactions to significant life experiences, to understand resilience development for managing later life health challenges.Methods: We applied a two-stage, cross-sectional mixed-methods design to the Cognitive Function and Ageing Studies Wales (CFAS Wales). Participants’ defined quantitatively as resilient (high level of well-being despite co-morbidity) were identified in the wave 1 dataset. A sub-sample of the resilient participants aged 65+ were randomly selected for semi-structured interviews (N=20). Qualitative thematic analyses were both inductive and deductive.Results: The analyses revealed four primary life experiences reflecting different developmental trajectories. ‘Early years as formative’ and ‘work and employment as formative’ occurred at normative developmental stages in the life-course. In contrast non-normative life events such as loss, bereavement, illness of self and others underpinned the themes of ‘adverse events and experiences’ and ‘caring experiences’. Four potential mechanisms for resilience were central to these life experiences, reflecting reactions, actions and development: ‘character and self-identity’; ‘approach to life and insight’; ‘meaningful relationships and belonging’.Conclusions: This work contributes further theoretical insights into the ecopsychosocial resilience framework. It highlights the process of interdependence between the individual and the wider environment, suggesting how the availability and accessibility of resources and human agency (protective factors), can influence, and be influenced by, the timing of significant events and experiences. In doing so, it corroborates international healthy ageing policy which recognises resilience as important for a public health response to support older people to adjust to changes and losses experienced in later life. It highlights the importance of current and future policies and services for supporting the management of adverse events earlier in the life-course, and recommends that policies and services take a ‘long view’ on population health and well-being and consider the whole life-course, in addition to specific points in the ageing process

Black Bear Density In Glacier National Park, Montana

No demographic information exists on the status of Glacier National Park’s (GNP) black bear (Ursus americanus) population. In 2004, we sampled the black bear population within GNP plus a 10 km buffer using noninvasive hair collection methods as part of a 7.8 million– acre study of the regional grizzly bear (U. arctos) population. We collected 5645 hair samples rom 550 baited hair traps, and 3807 samples from multiple visits to 1,542 natural bear rubs. Microsatellite analysis identified 601 (51% F) individuals from the 2848 samples identified as black bears. Data from individual bears were used in closed population mark–recapture models to estimate black bear population abundance. We developed an information-theoretic approach to estimate the effectively sampled area from which we calculated density for the6600 km2 greater GNP area. Preliminary results suggest that the density of GNP’s black bear population was equal to or greater than other interior populations sympatric with grizzlies, despite the high density of grizzlies. This project represents the first estimate of black bear density for this area, and demonstrates the efficiency of multi–species projects to inform management

Grizzly Bear and Black Bear Marking Behavior

Marking activity is common among ursids but little information has been quantified about this behavior. We describe marking behavior of sympatric grizzly bear (Ursus arctos) and black bear (U. americanus) populations in a 31,400-km2 area in northwestern Montana. We found marking activity in all areas occupied by bears regardless of bear density and land use. Based on examination of > 5000 bear marking sites, rubbing was the most common behavior at these sites. We used genetic analysis of hair collected at rubs to identify species, sex, and individual identity of bears using them and remotely-triggered cameras to observe bear behavior. Both grizzly bears and black bears rubbed; 58 percent of rubs had black bear hair, 25 percent grizzly hair, and 11 percent hair from both species. Bears typically marked standing trees (86%) but sign posts on hiking trails and forest roads, and power poles were also used. Only males rubbed May-June but female use increased substantially by late summer. Although cubs were detected at lower rates than older bears, all grizzly bear sex and age classes participated in rubbing. Many sites were rubbed repeatedly within and between years but there was also continual turnover. One function of rubbing appears to be chemical communication among bears, although this behavior is different from marking behavior observed in territorial species such as canids. With the high frequency of rubbing activity in these sympatric bear populations, hair from bear rubs provides a reliable and efficient way to concurrently sample both species to monitor population trends

Defining adolescent common mental disorders using electronic primary care data: a comparison with outcomes measured using the CIS-R

OBJECTIVE: To compare the prevalence of common mental disorders (CMDs) derived from data held in primary care records with that measured using the revised Clinical Interview Schedule (CIS-R) in order to assess the potential robustness of findings based only on routinely collected data. DESIGN AND SETTING: Comparison study using linkage between the Avon Longitudinal Study of Parents and Children (ALSPAC) and electronic primary care records. PARTICIPANTS: We studied 1562 adolescents who had completed the CIS-R in ALSPAC at age 17–18 years and had linkage established to their primary care records. OUTCOME MEASURES: Outcome measures from ALSPAC were whether or not an individual met International Classification of Diseases-10 criteria for a diagnosis of (1) a CMD or, specifically, (2) depression. Lists of Read codes corresponding to diagnoses, symptoms and treatments were used to create 12 definitions of CMD and depression alone using the primary care data. We calculated sensitivities and specificities of these, using CIS-R definitions as the reference standard. RESULTS: Sensitivities ranged from 5.2% to 24.3% for depression and from 3.8% to 19.2% for CMD. The specificities of all definitions were above 98% for depression and above 96% for CMD. For both outcomes, the definition that included current diagnosis, treatment or symptoms identified the highest proportion of CIS-R cases. CONCLUSIONS: Most individuals meeting case definitions for CMD based on primary care data also met CIS-R case definitions. Conversely many individuals identified as cases using the CIS-R had no evidence of CMD in their clinical records. This suggests that clinical databases are likely to yield underestimates of the burden of CMD in the population. However, clinical records appear to yield valid diagnoses which may be useful for studying risk factors and consequences of CMD. The greatest epidemiological value may be obtained when information is available from survey and clinical records

Evaluating Reproductive Success and Changes in Genetic Diversity of Grizzly Bears in Northwestern Montana

Current range expansions of large terrestrial carnivores are occurring following anthropogenically-induced range contraction. Contractions are often incomplete, leaving small remnant groups in refugia throughout the former range. We know little about underlying eco-evolutionary processes that influence how remnant groups are affected during range expansion. We used data from a spatially-explicit, long-term genetic sampling effort of grizzly bears (Ursus arctos) in the Northern Continental Divide Ecosystem (NCDE) to identify the processes underlying spatial patterns of genetic diversity. We conducted parentage analysis to evaluate how reproductive success and migration contribute to spatio-temporal patterns of genetic diversity in remnant groups of grizzly bears existing in the southwestern (SW), southeastern (SE), and east-central (EC) regions of the NCDE. Highly skewed reproductive success and local inbreeding caused distinct signatures in remnants that eroded rapidly (~1 generation) during population expansion and migration into the regions. Our results highlight that individual-level genetic and reproductive dynamics play critical roles during genetic assimilation, and show that patterns of genetic distinctiveness on the leading edge of an expansion may result from historical demographic patterns that are highly ephemeral

Using Linkage to Electronic Primary Care Records to Evaluate Recruitment and Nonresponse Bias in The Avon Longitudinal Study of Parents and Children

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