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

Different Ankle Joint Energetic Pattern Between Subjects with Copers and Ankle Instability

Please refer to the pdf version of the abstract located adjacent to the title

Vanishing Viscosity Limits and Boundary Layers for Circularly Symmetric 2D Flows

We continue the work of Lopes Filho, Mazzucato and Nussenzveig Lopes [LMN], on the vanishing viscosity limit of circularly symmetric viscous flow in a disk with rotating boundary, shown there to converge to the inviscid limit in $L^2$-norm as long as the prescribed angular velocity $\alpha(t)$ of the boundary has bounded total variation. Here we establish convergence in stronger $L^2$ and $L^p$-Sobolev spaces, allow for more singular angular velocities $\alpha$, and address the issue of analyzing the behavior of the boundary layer. This includes an analysis of concentration of vorticity in the vanishing viscosity limit. We also consider such flows on an annulus, whose two boundary components rotate independently. [LMN] Lopes Filho, M. C., Mazzucato, A. L. and Nussenzveig Lopes, H. J., Vanishing viscosity limit for incompressible flow inside a rotating circle, preprint 2006

Heat-kernel expansion on non compact domains and a generalised zeta-function regularisation procedure

Heat-kernel expansion and zeta function regularisation are discussed for Laplace type operators with discrete spectrum in non compact domains. Since a general theory is lacking, the heat-kernel expansion is investigated by means of several examples. It is pointed out that for a class of exponential (analytic) interactions, generically the non-compactness of the domain gives rise to logarithmic terms in the heat-kernel expansion. Then, a meromorphic continuation of the associated zeta function is investigated. A simple model is considered, for which the analytic continuation of the zeta function is not regular at the origin, displaying a pole of higher order. For a physically meaningful evaluation of the related functional determinant, a generalised zeta function regularisation procedure is proposed.Comment: Latex, 14 pages, no figures. The version to be published in JM

Maternal experiences of caring for an infant with neurological impairment after neonatal encephalopathy in Uganda: a qualitative study

Purpose: The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) (“birth asphyxia”) in Uganda. Methods: Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software. Findings: Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences. Conclusion: Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants. Implications for Rehabilitation Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers. Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers to maternal healthcare seeking. Studies examining the feasibility, acceptability and impact of early intervention programmes are warranted to maximise participation and improve the quality of life for affected mothers and their infants

Metabolic Comparison of One-Anastomosis Gastric Bypass, Single-Anastomosis Duodenal-Switch, Roux-en-Y Gastric Bypass, and Vertical Sleeve Gastrectomy in Rat

Background One-anastomosis gastric bypass (OAGB) and single-anastomosis duodenal switch (SADS) have become increasingly popular weight loss strategies. However, data directly comparing the effectiveness of these procedures with Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG) are limited. Objectives To examine the metabolic outcomes of OAGB, SADS, RYGB, and SG in a controlled rodent model. Setting Academic research laboratory, United States. Methods Surgeries were performed in diet-induced obese Long-Evans rats, and metabolic outcomes were monitored before and for 15 weeks after surgery. Results All bariatric procedures induced weight loss compared with sham that lasted throughout the course of the study. The highest percent fat loss occurred after OAGB and RYGB. All bariatric procedures had improved glucose dynamics associated with an increase in insulin (notably OAGB and SADS) and/or glucagon-like protein-1 secretion. Circulating cholesterol was reduced in OAGB, SG, and RYGB. OAGB and SG additionally decreased circulating triglycerides. Liver triglycerides were most profoundly reduced after OAGB and RYGB. Circulating iron levels were decreased in all surgical groups, associated with a decreased hematocrit value and increased reticulocyte count. The fecal microbiome communities of OAGB, SADS, and RYGB were significantly altered; however, SG exhibited no change in microbiome diversity or composition. Conclusions These data support the use of the rat for modeling bariatric surgical procedures and highlight the ability of the OAGB to meet or exceed the metabolic improvements of RYGB. These data point to the likelihood that each surgery accomplishes metabolic improvements through both overlapping and distinct mechanisms and warrants further research

Strong ellipticity and spectral properties of chiral bag boundary conditions

We prove strong ellipticity of chiral bag boundary conditions on even dimensional manifolds. From a knowledge of the heat kernel in an infinite cylinder, some basic properties of the zeta function are analyzed on cylindrical product manifolds of arbitrary even dimension.Comment: 16 pages, LaTeX, References adde

Entropy, Dynamics and Instantaneous Normal Modes in a Random Energy Model

It is shown that the fraction f of imaginary frequency instantaneous normal modes (INM) may be defined and calculated in a random energy model(REM) of liquids. The configurational entropy S and the averaged hopping rate among the states R are also obtained and related to f, with the results R~f and S=a+b*ln(f). The proportionality between R and f is the basis of existing INM theories of diffusion, so the REM further confirms their validity. A link to S opens new avenues for introducing INM into dynamical theories. Liquid 'states' are usually defined by assigning a configuration to the minimum to which it will drain, but the REM naturally treats saddle-barriers on the same footing as minima, which may be a better mapping of the continuum of configurations to discrete states. Requirements of a detailed REM description of liquids are discussed