Development and application of operational techniques for the inventory and monitoring of resources and uses for the Texas coastal zone

The author has identified the following significant results. The most significant ADP result was the modification of the DAM package to produce classified printouts, scaled and registered to U.S.G.S., 71/2 minute topographic maps from LARSYS-type classification files. With this modification, all the powerful scaling and registration capabilities of DAM become available for multiclass classification files. The most significant results with respect to image interpretation were the application of mapping techniques to a new, more complex area, and the refinement of an image interpretation procedure which should yield the best results

Living with an Older Person Dying from Cancer, Lung Disease or Dementia: Health Outcomes from a General Practice Cohort Study

CONTEXT: Increasing numbers of people will die from chronic disease. Families contribute significantly to end-of-life care but their role may not be recognized. OBJECTIVES: To 1) establish the proportion of older cohabitees identified in primary care as "carers;" 2) describe demographic and lifestyle characteristics of cohabitees of people terminally ill with cancer, dementia, and chronic obstructive pulmonary disease (COPD); 3) describe their health a year before and after bereavement; and 5) compare health outcomes between cohabitees of people dying with cancer, COPD, or dementia. METHODS: Retrospective cohort study using a U.K. primary care database (The Health Improvement Network) of 13,693 bereaved cohabitees (a proxy marker for being a carer), aged 60 years or older of people dying from cancer, COPD, or dementia. Characteristics were described one year before and after bereavement. We compared cancer, COPD, and dementia cohabitee outcomes using incidence rate ratios one year before and after bereavement and calculated mortality risk post-bereavement. RESULTS: A total of 6.9% of cohabitees were recorded as carers. Health outcomes differed little between the three groups of cohabitees in the year prior to or after bereavement. The proportion of cohabitees with six or more consultations increased the year after bereavement (cancer cohabitees 16.0% to 18.8%, COPD cohabitees 17.8% to 20.4% and dementia cohabitees 15.5% to 17.5%). At post-bereavement (follow-up median 3 years, IQR 1.3-5.4), we found no mortality differences between the three groups. CONCLUSION: Recording of carers of terminally ill people was suboptimal. Cause of bereavement produced few differential effects on health outcomes or mortality

Evaluating HIV treatment as prevention in the European context

Executive summary The goal of this project is to gather evidence regarding the population-level, and to some extent, individual-level effects of the use of antiretroviral treatment (ART) to prevent HIV infection, and to relate this to current HIV treatment guidelines. To inform the project, formal literature reviews were performed for the three main areas of interest: the effect of antiretroviral therapy in adults on preventing sexual transmission of HIV, prevention of mother-to-child transmission (pMTCT) and post exposure prophylaxis (PEP). The strongest evidence with regard to the effect of treatment of HIV positive individuals to prevent onwards sexual transmission comes from the recent randomised controlled trial (RCT), HPTN052. This study demonstrated that early versus delayed ART led to a 96% relative reduction in onwards linked transmission. Several observational studies of HIV sero-discordant heterosexual couples have also reported that transmission is rare in patients on ART, particularly in those with low HIV-RNA concentrations. However, the findings of HPTN052 and these observational studies are mainly applicable to vaginal heterosexual sex. No direct empirical evidence regarding the relationship between ART use and the risk of HIV transmission through anal intercourse is currently available. Whilst the major HIV treatment guidelines do not explicitly recommend prescribing antiretroviral treatment to prevent onwards transmission, they do not rule out individuals starting ART at a high CD4 count on a case-by-case basis. However, one must also consider the impact of earlier treatment on the HIV positive individual with regard to side effects, and development of drug resistance. Early studies showed that pMTCT regimens containing a single antiretroviral agent (short course zidovudine or single dose nevirapine) or two antiretroviral agents (zidovudine and lamivudine with or without single dose nevirapine) led to clinically important reductions in MTCT rates. However, the most substantial reductions in MTCT rates occurred when combination antiretroviral regimens (more than three antiretroviral drugs) were introduced. These regimens involve the receipt of ART before the third trimester of pregnancy, intrapartum treatment, maternal post-partum treatment and some form of neonatal treatment. There is some evidence from RCTs and extensive evidence from observational studies of the efficacy of these combination regimens, with very low rates of transmission of around 0% to 6%, in settings with no or very little breastfeeding, and 1%-9% when breastfeeding occurs. Furthermore, in settings where avoidance of breastfeeding is not possible, there are a number of studies demonstrating that receipt of maternal and/or neonatal ART during the six months after birth can reduce the risk of perinatal transmissions. All treatment guidelines recommend that HIV-positive pregnant women should receive ART to prevent MTCT, although the exact timing of when ART should begin is not always explicit. Furthermore, where mentioned, use of neonatal ART is also recommended, regardless of whether infants are breastfed. Much of the data supporting the use of PEP are based on animal models, which suggest that PEP is most efficacious if commenced as soon as possible after exposure. When considering occupational exposure to HIV, human studies are limited, as no RCTs exist for ethical reasons. Evidence for efficacy is based on one case control study which demonstrated an 81% reduction in transmission of HIV through the use of zidovudine. Other studies have demonstrated that PEP following occupational exposure is not always effective and there are cases of PEP failure. Similarly, there are also no RCTs assessing the efficacy of PEP for prevention of HIV transmission after sexual exposure, and limited evidence from observational data. Most treatment guidelines agree that PEP is not always effective and PEP policies need to emphasise the importance of risk prevention in the first place in all settings where there is a risk of HIV transmission. Side effects are not uncommon when using PEP, so it is important to consider carefully whether an individual should receive PEP and some studies have suggested that increase in availability of PEP may lead to an increase in risky sex behaviour. Antiretroviral treatment has well documented benefits in reducing transmission of HIV and, in particular, has had a major population level impact on HIV acquisition in children from HIV positive mothers. Further research is needed to help us understand how we can best use ART to prevent HIV infections through other transmission routes, and to develop evidence-based policy recommendations, particularly in the European context

CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE.

BACKGROUND: Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load. METHODS AND FINDINGS: Using data from the Collaboration of Observational HIV Epidemiological Research Europe (2010 merger), we assessed the risk of a new AIDS-defining event or death in successfully treated patients. We accumulated episodes of viral suppression for each patient while on cART, each episode beginning with the second of two consecutive plasma viral load measurements 500 copies/µl, the first of two consecutive measurements between 50-500 copies/µl, cART interruption or administrative censoring. We used stratified multivariate Cox models to estimate the association between time updated CD4 cell count and a new AIDS event or death or death alone. 75,336 patients contributed 104,265 suppression episodes and were suppressed while on cART for a median 2.7 years. The mortality rate was 4.8 per 1,000 years of viral suppression. A higher CD4 cell count was always associated with a reduced risk of a new AIDS event or death; with a hazard ratio per 100 cells/µl (95% CI) of: 0.35 (0.30-0.40) for counts <200 cells/µl, 0.81 (0.71-0.92) for counts 200 to <350 cells/µl, 0.74 (0.66-0.83) for counts 350 to <500 cells/µl, and 0.96 (0.92-0.99) for counts ≥500 cells/µl. A higher CD4 cell count became even more beneficial over time for patients with CD4 cell counts <200 cells/µl. CONCLUSIONS: Despite the low mortality rate, the risk of a new AIDS event or death follows a CD4 cell count gradient in patients with viral suppression. A higher CD4 cell count was associated with the greatest benefit for patients with a CD4 cell count <200 cells/µl but still some slight benefit for those with a CD4 cell count ≥500 cells/µl

HIV in hiding: methods and data requirements for the estimation of the number of people living with undiagnosed HIV

Many people who are HIV positive are unaware of their infection status. Estimation of the number of people with undiagnosed HIV within a country or region is vital for understanding future need for treatment and for motivating testing programs. We review the available estimation approaches which are in current use. They can be broadly classified into those based on prevalence surveys and those based on reported HIV and AIDS cases. Estimation based on prevalence data requires data from regular prevalence surveys in different population groups together with estimates of the size of these groups. The recommended minimal case reporting data needed to estimate the number of patients with undiagnosed HIV are HIV diagnoses, including CD4 count at diagnosis and whether there has been an AIDS diagnosis in the 3 months before or after HIV diagnosis, and data on deaths in people with HIV. We would encourage all countries to implement several methods that will help develop our understanding of strengths and weaknesses of the various methods

Arable weed seeds as indicators of regional cereal provenance: a case study from Iron Age and Roman central-southern Britain

The ability to provenance crop remains from archaeological sites remains an outstanding research question in archaeology. Archaeobotanists have previously identified the movement of cereals on the basis of regional variations in the presence of cereal grain, chaff and weed seeds (the consumer–producer debate), and weed seeds indicative of certain soil types, principally at Danebury hillfort. Whilst the former approach has been heavily criticised over the last decade, the qualitative methods of the latter have not been evaluated. The first interregional trade in cereals in Britain is currently dated to the Iron Age hillfort societies of the mid 1st millennium bc. Several centuries later, the development of urban settlements in the Late Iron Age and Roman period resulted in populations reliant on food which was produced elsewhere. Using the case study of central-southern Britain, centred on the oppidum (large fortified settlement) and civitas capital of Silchester, this paper presents the first regional quantitative analysis of arable weed seeds in order to identify the origin of the cereals consumed there. Analysis of the weed seeds which were present with the fine sieve by-products of the glume wheat Triticum spelta (spelt) shows that the weed floras of samples from diverse geological areas can be separated on the basis of the soil requirements of individual taxa. A preliminary finding is that, rather than being supplied with cereals from the wider landscape of the chalk region of the Hampshire Downs, the crops were grown close to Late Iron Age Silchester. The method presented here requires further high quality samples to evaluate this conclusion and other instances of cereal movement in the past

Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe

Objectives The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. Methods We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged 500 HIV-1 RNA copies/mL despite >= 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. Results The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0-12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9-5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10-14 years when starting ART (27.7%; 95% CI 13.2-42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10-14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4. Conclusions The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development

'The debatable territory where geology and archaeology meet': reassessing the early archaeobotanical work of Clement Reid and Arthur Lyell at Roman Silchester

The first large-scale archaeobotanical study in Britain, conducted from 1899 to 1909 by Clement Reid and Arthur Lyell at Silchester, provided the first evidence for the introduction of Roman plant foods to Britain, yet the findings have thus far remained unverified. This paper presents a reassessment of these archaeobotanical remains, now stored as part of the Silchester Collection in Reading Museum. The documentary evidence for the Silchester study is summarised, before the results are presented for over a 1000 plant remains including an assessment of preservation, identification and modern contamination. The dataset includes both evidence for the presence of nationally rare plant foods, such as medlar, and several archaeophytes. The methodologies and original interpretations of Reid and Lyell’s study are reassessed in light of current archaeobotanical knowledge. Spatial and contextual patterns in the distribution of plant foods and ornamental taxa are also explored. Finally, the legacy of the study for the development of archaeobotany in the 20th century is evaluated