When information does not suffice: young people living with HIV and communication about ART adherence in the clinic.

Despite mounting evidence recommending disclosure of human immunodeficiency virus (HIV) status to young people with perinatally acquired HIV as a central motivating factor for adherence to antiretroviral therapy, many young people continue to experience disclosure as a partial event, rather than a process. Drawing from two longitudinal, interview-based qualitative studies with young people living with HIV (aged 10-24) in five different countries in low and high income settings, we present data regarding disclosure and information about HIV in the clinic. The article highlights the limits of discussions framing disclosure and patient literacy, and young people's reluctance to voice their adherence difficulties in the context of their relationships with clinical care teams. We suggest that a clinician-initiated, explicit acknowledgment of the social and practical hurdles of daily adherence for young people would aid a more transparent conversation and encourage young people to disclose missed doses and other problems they may be facing with their treatment. This may help to reduce health harms and poor adherence in the longer-term

Dust Stratification in Young Circumstellar Disks

We present high-resolution infrared spectra of four YSOs (T Tau N, T Tau S, RNO 91, and HL Tau). The spectra exhibit narrow absorption lines of 12CO, 13CO, and C18O as well as broad emission lines of gas phase12CO. The narrow absorption lines of CO are shown to originate from the colder circumstellar gas. We find that the line of sight gas column densities resulting from the CO absorption lines are much higher than expected for the measured extinction for each source and suggest the gas to dust ratio is measuring the dust settling and/or grain coagulation in these extended disks. We provide a model of turbulence, dust settling and grain growth to explain the results. The techniques presented here allow us to provide some observationally-motivated bounds on accretion disk alpha in protostellar systems

Logics, rhetoric and 'the blob': populist logic in the Conservative reforms to English schooling

A lot has been written about the lasting implications of the Conservative reforms to English schooling, particularly changes made by Michael Gove as Education Secretary (2010–2014). There is a lot less work, however, on studying the role that language, strategy and the broader political framework played in the process of instituting and winning consent for these reforms. Studying these factors is important for ensuring that any changes to education and schooling are not read in isolation from their political context. Speeches particularly capture moments where intellectual and strategic political traditions meet, helping us to form a richer understanding of the motives behind specific reform goals and where they fit into a political landscape. This article analyses speeches and policy documents from prominent politicians who led the Conservative education agenda between 2010–2014 to illustrate how politicians mobilised a deliberate populist strategy and argumentation to achieve specific educational goals, but which have had broader social and political implications. Concepts from interpretive political studies are used to develop a case analysis of changes to teacher training provision and curriculum reform, illustrating how politicians constructed a frontier between ‘the people’ (commonly teachers or parents) and an illegitimate ‘elite’ (an educational establishment) that opposed change. This anti‐elite populist rhetoric, arguably first tested in the Department for Education, has now become instituted more widely in our current British politics

Ethical Allocation of Remdesivir

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them wors

Elevated plasma levels of TIMP-3 are associated with a higher risk of acute respiratory distress syndrome and death following severe isolated traumatic brain injury.

BackgroundComplications after injury, such as acute respiratory distress syndrome (ARDS), are common after traumatic brain injury (TBI) and associated with poor clinical outcomes. The mechanisms driving non-neurologic organ dysfunction after TBI are not well understood. Tissue inhibitor of matrix metalloproteinase-3 (TIMP-3) is a regulator of matrix metalloproteinase activity, inflammation, and vascular permeability, and hence has plausibility as a biomarker for the systemic response to TBI.MethodsIn a retrospective study of 182 patients with severe isolated TBI, we measured TIMP-3 in plasma obtained on emergency department arrival. We used non-parametric tests and logistic regression analyses to test the association of TIMP-3 with the incidence of ARDS within 8 days of admission and in-hospital mortality.ResultsTIMP-3 was significantly higher among subjects who developed ARDS compared with those who did not (median 2810 pg/mL vs. 2260 pg/mL, p=0.008), and significantly higher among subjects who died than among those who survived to discharge (median 2960 pg/mL vs. 2080 pg/mL, p<0.001). In an unadjusted logistic regression model, for each SD increase in plasma TIMP-3, the odds of ARDS increased significantly, OR 1.5 (95% CI 1.1 to 2.1). This association was only attenuated in multivariate models, OR 1.4 (95% CI 1.0 to 2.0). In an unadjusted logistic regression model, for each SD increase in plasma TIMP-3, the odds of death increased significantly, OR 1.7 (95% CI 1.2 to 2.3). The magnitude of this association was greater in a multivariate model adjusted for markers of injury severity, OR 1.9 (95% CI 1.2 to 2.8).DiscussionTIMP-3 may play an important role in the biology of the systemic response to brain injury in humans. Along with clinical and demographic data, early measurements of plasma biomarkers such as TIMP-3 may help identify patients at higher risk of ARDS and death after severe isolated TBI.Level of evidenceIII

Post-Outburst Observations of V1647 Ori: Detection of a Brief Warm, Molecular Outflow

We present new observations of the fundamental ro-vibrational CO spectrum of V1647 Ori, the young star whose recent outburst illuminated McNeil's Nebula. Previous spectra, acquired during outburst in 2004 February and July, had shown the CO emission lines to be broad and centrally peaked-similar to the CO spectrum of a typical classical T Tauri star. In this paper, we present CO spectra acquired shortly after the luminosity of the source returned to its pre-outburst level (2006 February) and roughly one year later (2006 December and 2007 February). The spectrum taken in 2006 February revealed blue-shifted CO absorption lines superimposed on the previously observed CO emission lines. The projected velocity, column density, and temperature of this outflowing gas was 30 km/s, 3^{+2}_{-1}E18 cm^{-2$, and 700^{+300}_{-100} K, respectively. The absorption lines were not observed in the 2006 December and 2007 February data, and so their strengths must have decreased in the interim by a factor of 9 or more. We discuss three mechanisms that could give rise to this unusual outflow.Comment: 14 pages, 2 figures, accepted for publication in ApJ

Parents mimic and influence their infant’s autonomic state through dynamic affective state matching

When we see someone experiencing an emotion, and when we experience it ourselves, common neurophysiological activity occurs [1, 2]. But although inter-dyadic synchrony, concurrent and sequential [3], has been identified, its functional significance remains inadequately understood. Specifically, how do influences of partner A on partner B reciprocally influence partner A? For example, if I am experiencing an affective state and someone matches their physiological state to mine, what influence does this have on me – the person experiencing the emotion? Here, we investigated this using infant-parent dyads. We developed miniaturised microphones to record spontaneous vocalisations and wireless autonomic monitors to record heart rate, heart rate variability and movement in infants and parents concurrently in naturalistic settings. Overall, we found that infant-parent autonomic activity did not covary across the day – but that ‘high points’ of infant arousal led to autonomic changes in the parent, and that instances where the adult showed greater autonomic responsivity were associated with faster infant quieting. Parental responsivity was higher following peaks in infant negative affect than in positive affect. Overall, parents responded to increases in their child’s arousal by increasing their own. However, when the overall arousal level of the dyad was high, parents responded to elevated child arousal by decreasing their own arousal. Our findings suggest that autonomic state matching has a direct effect on the person experiencing the affective state, and that parental co-regulation may involve both connecting, and disconnecting, their own arousal state from that of the child contingent on context

Prevalence of liver fluke (Fasciola hepatica) in wild Red Deer (Cervus elaphus): coproantigen ELISA is a practicable alternative to faecal egg counting for surveillance in remote populations

Red deer (Cervus elaphus) are hosts of liver fluke (Fasciola hepatica); yet, prevalence is rarely quantified in wild populations. Testing fresh samples from remote regions by faecal examination (FE) can be logistically challenging; hence, we appraise frozen storage and the use of a coproantigen ELISA (cELISA) for F. hepatica surveillance. We also present cELISA surveillance data for red deer from the Highlands of Scotland. Diagnoses in faecal samples (207 frozen, 146 fresh) were compared using a cELISA and by FE. For each storage method (frozen or fresh), agreement between the two diagnostics was estimated at individual and population levels, where population prevalence was stratified into cohorts (e.g., by sampling location). To approximate sensitivity and specificity, 65 post-slaughter whole liver examinations were used as a reference. At the individual level, FE and cELISA diagnoses agreed moderately (κfrozen = 0.46; κfresh = 0.51), a likely reflection of their underlying principles. At the population level, FE and cELISA cohort prevalence correlated strongly (Pearson’s R = 0.89, p < 0.0001), reflecting good agreement on relative differences between cohort prevalence. In frozen samples, prevalence by cELISA exceeded FE overall (42.8% vs. 25.8%) and in 9/12 cohorts, alluding to differences in sensitivity; though, in fresh samples, no significant difference was found. In 959 deer tested by cELISA across the Scottish Highlands, infection prevalence ranged from 9.6% to 53% by sampling location. We highlight two key advantages of cELISA over FE: i) the ability to store samples long term (frozen) without apparent loss in diagnostic power; and ii) reduced labour and the ability to process large batches. Further evaluation of cELISA sensitivity in red deer, where a range of fluke burdens can be obtained, is desirable. In the interim, the cELISA is a practicable diagnostic for F. hepatica surveillance in red deer, and its application here has revealed considerable geographic, temporal, sex and age related differences in F. hepatica prevalence in wild Scottish Highland red deer

Phytoplasmas in Australian grapevines - detection, differentiation and associated diseases

Phytoplasmas associated with Australian grapevine yellows (AGY) symptoms were detected using the polymerase chain reaction (PCR). To optimise the diagnostic, nested PCRs were compared with single PCRs using different primer pairs. Grapevine DNA known to be AGY phytoplasma positive was serially diluted and subjected to nested and single round PCR tests to determine which was the most sensitive. Samples taken over two growing seasons were used to determine the optimum sampling time for phytoplasma detection. The specificity of primer pairs was determined using phytoplasmas detected in Australian grapevines and overseas reference grapevine phytoplasmas. DNA extracted from grapevine exhibiting a range of symptoms was screened for phytoplasmas. Two different phytoplasmas were amplified in the PCR and they were identified using specific PCR primers and by restriction fragment length polymorphism (RFLP) analysis of the 16S rRNA gene and 16S rRNA/23S rRNA spacer region. RFLP analysis confirmed that one phytoplasma was the AGY phytoplasma and the other phytoplasma was indistinguishable from the tomato big bud (TBB) phytoplasma. The AGY phytoplasma was associated with AGY symptoms but was occasionally detected in asymptomatic vines and those with late season leaf curl (LSLC) and restricted growth (RG) symptoms. The TBB phytoplasma was detected in some vines with LSLC symptoms and very occasionally in vines with AGY symptoms. A 'variant' of the AGY phytoplasma was also detected in vines showing typical AGY symptoms