Impact of definitions of loss to follow-up (LTFU) in antiretroviral therapy program evaluation: variation in the definition can have an appreciable impact on estimated proportions of LTFU

OBJECTIVE To examine the impact of different definitions of loss to follow-up (LTFU) on estimates of program outcomes in cohort studies of patients on antiretroviral therapy (ART). STUDY DESIGN AND SETTING We examined the impact of different definitions of LTFU using data from the International Epidemiological Databases to Evaluate AIDS-Southern Africa. The reference approach, Definition A, was compared with five alternative scenarios that differed in eligibility for analysis and the date assigned to the LTFU outcome. Kaplan-Meier estimates of LTFU were calculated up to 2 years after starting ART. RESULTS Estimated cumulative LTFU were 14% and 22% at 12 and 24 months, respectively, using the reference approach. Differences in the proportion LTFU were reported in the alternative scenarios with 12-month estimates of LTFU varying by up to 39% compared with Definition A. Differences were largest when the date assigned to the LTFU outcome was 6 months after the date of last contact and when the site-specific definition of LTFU was used. CONCLUSION Variation in the definitions of LTFU within cohort analyses can have an appreciable impact on estimated proportions of LTFU over 2 years of follow-up. Use of a standardized definition of LTFU is needed to accurately measure program effectiveness and comparability between programs.

Hydrogen embrittlement risk of high strength galvanized steel in contact with alkaline media

The critical conditions for hydrogenembrittlement (HE) risk of highstrengthgalvanizedsteel (HSGS) wires and tendons exposed to alkaline concrete pore solutions have been evaluated by means of electrochemical and mechanical testing. There is a relationship between the hydrogenembrittlementrisk in HSGS and the length of hydrogen evolution process in alkalinemedia. The galvanizedsteel suffers anodic dissolution simultaneously to the hydrogen evolution which does not stop until the passivation process is completed. HSGS wires exposed to a very highalkalinemedia have showed HE risk with loss in mechanical properties only if long periods with hydrogen evolution process take place with a simultaneous intensive galvanized coating reduction.

Wheel-Rail Contact Forces in High-Speed Simply Supported Bridges at Resonance

The response of high-speed bridges at resonance, particularly under flexural vibrations, constitutes a subject of research for many scientists and engineers at the moment. The topic is of great interest because, as a matter of fact, such kind of behaviour is not unlikely to happen due to the elevated operating speeds of modern rains, which in many cases are equal to or even exceed 300 km/h ( [1,2]). The present paper addresses the subject of the evolution of the wheel-rail contact forces during resonance situations in simply supported bridges. Based on a dimensionless formulation of the equations of motion presented in [4], very similar to the one introduced by Klasztorny and Langer in [3], a parametric study is conducted and the contact forces in realistic situations analysed in detail. The effects of rail and wheel irregularities are not included in the model. The bridge is idealised as an Euler-Bernoulli beam, while the train is simulated by a system consisting of rigid bodies, springs and dampers. The situations such that a severe reduction of the contact force could take place are identified and compared with typical situations in actual bridges. To this end, the simply supported bridge is excited at resonace by means of a theoretical train consisting of 15 equidistant axles. The mechanical characteristics of all axles (unsprung mass, semi-sprung mass, and primary suspension system) are identical. This theoretical train permits the identification of the key parameters having an influence on the wheel-rail contact forces. In addition, a real case of a 17.5 m bridges traversed by the Eurostar train is analysed and checked against the theoretical results. The influence of three fundamental parameters is investigated in great detail: a) the ratio of the fundamental frequency of the bridge and natural frequency of the primary suspension of the vehicle; b) the ratio of the total mass of the bridge and the semi-sprung mass of the vehicle and c) the ratio between the length of the bridge and the characteristic distance between consecutive axles. The main conclusions derived from the investigation are: The wheel-rail contact forces undergo oscillations during the passage of the axles over the bridge. During resonance, these oscillations are more severe for the rear wheels than for the front ones. If denotes the span of a simply supported bridge, and the characteristic distance between consecutive groups of loads, the lower the value of , the greater the oscillations of the contact forces at resonance. For or greater, no likelihood of loss of wheel-rail contact has been detected. The ratio between the frequency of the primary suspension of the vehicle and the fundamental frequency of the bridge is denoted by (frequency ratio), and the ratio of the semi-sprung mass of the vehicle (mass of the bogie) and the total mass of the bridge is denoted by (mass ratio). For any given frequency ratio, the greater the mass ratio, the greater the oscillations of the contact forces at resonance. The oscillations of the contact forces at resonance, and therefore the likelihood of loss of wheel-rail contact, present a minimum for approximately between 0.5 and 1. For lower or higher values of the frequency ratio the oscillations of the contact forces increase. Neglecting the possible effects of torsional vibrations, the metal or composite bridges with a low linear mass have been found to be the ones where the contact forces may suffer the most severe oscillations. If single-track, simply supported, composite or metal bridges were used in high-speed lines, and damping ratios below 1% were expected, the minimum contact forces at resonance could drop to dangerous values. Nevertheless, this kind of structures is very unusual in modern high-speed railway lines.

Diseño y configuración de una red de comunicaciones en un Centro de Contactos - Contact Center

Este proyecto muestra una solución de red para una empresa que presta servicios de Contact Center desde distintas sedes distribuidas geográficamente, utilizando la tecnología de telefonía sobre IP. El objetivo de este proyecto es el de convertirse en una guía de diseño para el despliegue de soluciones de red utilizando los actuales equipos de comunicaciones desarrollados por el fabricante Cisco Systems, Inc., los equipos de seguridad desarrollados por el fabricante Fortinet y los sistemas de telefonía desarrollados por Avaya Inc. y Oracle Corporation, debido a su gran penetración en el mercado y a las aportaciones que cada uno ha realizado en el sector de Contact Center. Para poder proveer interconexión entre las sedes de un Contact Center se procede a la contratación de un acceso a la red MPLS perteneciente a un operador de telecomunicaciones, quien provee conectividad entre las sedes utilizando la tecnología VPN MPLS con dos accesos diversificados entre sí desde cada una de las sedes del Contact Center. El resultado de esta contratación es el aprovechamiento de las ventajas que un operador de telecomunicaciones puede ofrecer a sus clientes, en relación a calidad de servicio, disponibilidad y expansión geográfica. De la misma manera, se definen una serie de criterios o niveles de servicio que aseguran a un Contact Center una comunicación de calidad entre sus sedes, entendiéndose por comunicación de calidad aquella que sea capaz de transmitirse con unos valores mínimos de pérdida de paquetes así como retraso en la transmisión, y una velocidad acorde a la demanda de los servicios de voz y datos. Como parte de la solución, se diseña una conexión redundante a Internet que proporciona acceso a todas las sedes del Contact Center. La solución de conectividad local en cada una de las sedes de un Contact Center se ha diseñado de manera general acorde al volumen de puestos de usuarios y escalabilidad que pueda tener cada una de las sedes. De esta manera se muestran varias opciones asociadas al equipamiento actual que ofrece el fabricante Cisco Systems, Inc.. Como parte de la solución se han definido los criterios de calidad para la elección de los Centros de Datos (Data Center). Un Contact Center tiene conexiones hacia o desde las empresas cliente a las que da servicio y provee de acceso a la red a sus tele-trabajadores. Este requerimiento junto con el acceso y servicios publicados en Internet necesita una infraestructura de seguridad. Este hecho da lugar al diseño de una solución que unifica todas las conexiones bajo una única infraestructura, dividiendo de manera lógica o virtual cada uno de los servicios. De la misma manera, se ha definido la utilización de protocolos como 802.1X para evitar accesos no autorizados a la red del Contact Center. La solución de voz elegida es heterogénea y capaz de soportar los protocolos de señalización más conocidos (SIP y H.323). De esta manera se busca tener la máxima flexibilidad para establecer enlaces de voz sobre IP (Trunk IP) con proveedores y clientes. Esto se logra gracias a la utilización de SBCs y a una infraestructura interna de voz basada en el fabricante Avaya Inc. Los sistemas de VoIP en un Contact Center son los elementos clave para poder realizar la prestación del servicio; por esta razón se elige una solución redundada bajo un entorno virtual. Esta solución permite desplegar el sistema de VoIP desde cualquiera de los Data Center del Contact Center. La solución llevada a cabo en este proyecto está principalmente basada en mi experiencia laboral adquirida durante los últimos siete años en el departamento de comunicaciones de una empresa de Contact Center. He tenido en cuenta los principales requerimientos que exigen hoy en día la mayor parte de empresas que desean contratar un servicio de Contact Center. Este proyecto está dividido en cuatro capítulos. El primer capítulo es una introducción donde se explican los principales escenarios de negocio y áreas técnicas necesarias para la prestación de servicios de Contact Center. El segundo capítulo describe de manera resumida, las principales tecnologías y protocolos que serán utilizados para llevar a cabo el diseño de la solución técnica de creación de una red de comunicaciones para una empresa de Contact Center. En el tercer capítulo se expone la solución técnica necesaria para permitir que una empresa de Contact Center preste sus servicios desde distintas ubicaciones distribuidas geográficamente, utilizando dos Data Centers donde se centralizan las aplicaciones de voz y datos. Finalmente, en el cuarto capítulo se presentan las conclusiones obtenidas tras la elaboración de la presente memoria, así como una propuesta de trabajos futuros, que permitirían junto con el proyecto actual, realizar una solución técnica completa incluyendo otras áreas tecnológicas necesarias en una empresa de Contact Center. Todas las ilustraciones y tablas de este proyecto son de elaboración propia a partir de mi experiencia profesional y de la información obtenida en diversos formatos de la bibliografía consultada, excepto en los casos en los que la fuente es mencionada. ABSTRACT This project shows a network solution for a company that provides Contact Center services from different locations geographically distributed, using the Telephone over Internet Protocol (ToIP) technology. The goal of this project is to become a design guide for performing network solutions using current communications equipment developed by the manufacturer Cisco Systems, Inc., firewalls developed by the manufacturer Fortinet and telephone systems developed by Avaya Inc. and Oracle Corporation, due to their great market reputation and their contributions that each one has made in the field of Contact Center. In order to provide interconnection between its different sites, the Contact Center needs to hire the services of a telecommunications’ operator, who will use the VPN MPLS technology, with two diversified access from each Contact Center’s site. The result of this hiring is the advantage of the benefits that a telecommunications operator can offer to its customers, regarding quality of service, availability and geographical expansion. Likewise, Service Level Agreement (SLA) has to be defined to ensure the Contact Center quality communication between their sites. A quality communication is understood as a communication that is capable of being transmitted with minimum values of packet loss and transmission delays, and a speed according to the demand for its voice and data services. As part of the solution, a redundant Internet connection has to be designed to provide access to every Contact Center’s site. The local connectivity solution in each of the Contact Center’s sites has to be designed according to its volume of users and scalability that each one may have. Thereby, the manufacturer Cisco Systems, Inc. offers several options associated with the current equipment. As part of the solution, quality criteria are being defined for the choice of the Data Centers. A Contact Center has connections to/from the client companies that provide network access to teleworkers. This requires along the access and services published on the Internet, needs a security infrastructure. Therefore is been created a solution design that unifies all connections under a single infrastructure, dividing each services in a virtual way. Likewise, is been defined the use of protocols, such as 802.1X, to prevent unauthorized access to the Contact Center’s network. The voice solution chosen is heterogeneous and capable of supporting best-known signaling protocols (SIP and H.323) in order to have maximum flexibility to establish links of Voice over IP (IP Trunk) with suppliers and clients. This can be achieved through the use of SBC and an internal voice infrastructure based on Avaya Inc. The VoIP systems in a Contact Center are the key elements to be able to provide the service; for this reason a redundant solution under virtual environment is been chosen. This solution allows any of the Data Centers to deploy the VoIP system. The solution carried out in this project is mainly based on my own experience acquired during the past seven years in the communications department of a Contact Center company. I have taken into account the main requirements that most companies request nowadays when they hire a Contact Center service. This project is divided into four chapters. The first chapter is an introduction that explains the main business scenarios and technical areas required to provide Contact Center services. The second chapter describes briefly the key technologies and protocols that will be used to carry out the design of the technical solution for the creation of a communications network in a Contact Center company. The third chapter shows a technical solution required that allows a Contact Center company to provide services from across geographically distributed locations, using two Data Centers where data and voice applications are centralized. Lastly, the fourth chapter includes the conclusions gained after making this project, as well as a future projects proposal, which would allow along the current project, to perform a whole technical solution including other necessary technologic areas in a Contact Center company All illustrations and tables of this project have been made by myself from my professional experience and the information obtained in various formats of the bibliography, except in the cases where the source is indicated.

Transition-state structure as a unifying basis in protein-folding mechanisms: Contact order, chain topology, stability, and the extended nucleus mechanism

I attempt to reconcile apparently conflicting factors and mechanisms that have been proposed to determine the rate constant for two-state folding of small proteins, on the basis of general features of the structures of transition states. Φ-Value analysis implies a transition state for folding that resembles an expanded and distorted native structure, which is built around an extended nucleus. The nucleus is composed predominantly of elements of partly or well-formed native secondary structure that are stabilized by local and long-range tertiary interactions. These long-range interactions give rise to connecting loops, frequently containing the native loops that are poorly structured. I derive an equation that relates differences in the contact order of a protein to changes in the length of linking loops, which, in turn, is directly related to the unfavorable free energy of the loops in the transition state. Kinetic data on loop extension mutants of CI2 and α-spectrin SH3 domain fit the equation qualitatively. The rate of folding depends primarily on the interactions that directly stabilize the nucleus, especially those in native-like secondary structure and those resulting from the entropy loss from the connecting loops, which vary with contact order. This partitioning of energy accounts for the success of some algorithms that predict folding rates, because they use these principles either explicitly or implicitly. The extended nucleus model thus unifies the observations of rate depending on both stability and topology.

Natural Compounds from Saffron and Bear Bile Prevent Vision Loss and Retinal Degeneration

All retinal disorders, regardless of their aetiology, involve the activation of oxidative stress and apoptosis pathways. The administration of neuroprotective factors is crucial in all phases of the pathology, even when vision has been completely lost. The retina is one of the most susceptible tissues to reactive oxygen species damage. On the other hand, proper development and functioning of the retina requires a precise balance between the processes of proliferation, differentiation and programmed cell death. The life-or-death decision seems to be the result of a complex balance between pro- and anti-apoptotic signals. It has been recently shown the efficacy of natural products to slow retinal degenerative process through different pathways. In this review, we assess the neuroprotective effect of two compounds used in the ancient pharmacopoeia. On one hand, it has been demonstrated that administration of the saffron constituent safranal to P23H rats, an animal model of retinitis pigmentosa, preserves photoreceptor morphology and number, the capillary network and the visual response. On the other hand, it has been shown that systemic administration of tauroursodeoxycholic acid (TUDCA), the major component of bear bile, to P23H rats preserves cone and rod structure and function, together with their contact with postsynaptic neurons. The neuroprotective effects of safranal and TUDCA make these compounds potentially useful for therapeutic applications in retinal degenerative diseases.

The Promise and the Price of Contact: Puyallup Indian Acculturation, Federal Indian Policy and the City of Tacoma, 1832-1909

Thesis (Ph.D.)--University of Washington, 2016-06

Minimal mutation of the cytoplasmic tail inhibits the ability of E-cadherin to activate Rac but not phosphatidylinositol 3-kinase - Direct evidence of a role for cadherin-activated Rac signaling in adhesion and contact formation

Classic cadherins are adhesion-activated cell signaling receptors. In particular, homophilic cadherin ligation can directly activate Rho family GTPases and phosphatidylinositol 3-kinase (PI3-kinase), signaling molecules with the capacity to support the morphogenetic effects of these adhesion molecules during development and disease. However, the molecular basis for cadherin signaling has not been elucidated, nor is its precise contribution to cadherin function yet understood. One attractive hypothesis is that cadherin-activated signaling participates in stabilizing adhesive contacts ( Yap, A. S., and Kovacs, E. M. ( 2003) J. Cell Biol. 160, 11-16). We now report that minimal mutation of the cadherin cytoplasmic tail to uncouple binding of p120-ctn ablated the ability of E-cadherin to activate Rac. This was accompanied by profound defects in the capacity of cells to establish stable adhesive contacts, defects that were rescued by sustained Rac signaling. These data provide direct evidence for a role of cadherin-activated Rac signaling in contact formation and adhesive stabilization. In contrast, cadherin-activated PI3-kinase signaling was not affected by loss of p120-ctn binding. The molecular requirements for E-cadherin to activate Rac signaling thus appear distinct from those that stimulate PI3-kinase, and we postulate that p120-ctn may play a central role in the E-cadherin-Rac signaling pathway.

Heritage language loss and the implications for ethnic identity maintenance over time

Language has been seen as a central pillar to ethnic identity. When the possibility of heritage language loss becomes imminent, therefore, concern turns towards the consequences for feelings of ethnic group membership. Heritage language researchers have indicated that the heritage language is so strongly associated with the individual’s cultural background that heritage language loss could have negative implications for the sense of identity to the ethnic group. This study investigates the relationship between language and ethnic identity over time among Gaelic learners in Nova Scotia. In order to identify the specific processes of heritage language use, the Gaelic learners are compared to French (second language), learners living in the same English-speaking milieu. Path analyses reveal that, only among Gaelic learners, there is an initial separation of language and ethnic identity, but that, over time, ethnic identity is a direct outcome of language use. The results support Edwards’ (1985), contention, at least in the case of heritage languages, that language and identity are not always strongly linked. It is suggested that this may be especially true in contexts where there is little opportunity for contact with members of the heritage language group.

Philosophy's loss, neurology's gain:the endeavor of John Hughlings-Jackson

The year 2011 marked the centenary of the death of one of the founders of British neurology, John Hughlings-Jackson (1835-1911). By common consent he was a great clinician. But he was more. He endeavored to use clinical observations to throw light on one of the great problems of the modern world, the problem of mind. Hughlings-Jackson's daily contact with mentalities warped by neurological disease caused him to ponder deeply the nature of the mind-brain relationship, nowadays often known simply as the "hard problem. " In particular, he saw the danger of conflating mind and brain, a danger that has grown greater with the spectacular growth of neuroscientific knowledge during the last century. Although Hughlings-Jackson's neuroscientific thought is long outdated, his philosophic endeavors remain highly instructive. © 2012 by The Johns Hopkins University Press.

Simulations of forest loss in North America, the Amazon, and combined using the Community Earth System Model

The netcdf files in this archive comprise climate model output from Community Earth System Model for experiments looking at forest loss over Western North America and the Amazon. For further description of the model and configuration for these experiments please see the accompanying manuscript: Synergistic ecoclimate teleconnections from forest loss in different regions structure global ecological responses Elizabeth S. Garcia, Abigail L. S. Swann, Juan C. Villegas, David D. Breshears, Darin J. Law, Scott R. Saleska, and Scott C. Stark published in PLOS ONE, 2016. Contact information in README.txt

Chronic Telogen Effluvium And Female Pattern Hair Loss Are Separate And Distinct Forms Of Alopecia: A Histomorphometric And Immunohistochemical Analysis.

Chronic telogen effluvium (CTE), a poorly understood condition, can be confused with or may be a prodrome to female pattern hair loss (FPHL). The pathogenesis of both is related to follicle cycle shortening and possibly to blood supply changes. To analyze a number of histomorphometric and immunohistochemical findings through vascular endothelial growth factor (VEGF), Ki-67, and CD31 immunostaining in scalp biopsies of 20 patients with CTE, 17 patients with mild FPHL and 9 controls. Ki-67 index and VEGF optical density were analyzed at the follicular outer sheath using ImageJ software. CD31 microvessel density was assessed by a Chalkley grid. Significant follicle miniaturization and higher density of nonanagen follicles were found in FPHL, compared with patients with CTE and controls. Ki-67+ index correlated positively with FPHL histological features. The FPHL group showed the highest VEGF optical density, followed by the CTE and control groups. No differences were found in CD31 microvessel density between the three groups. Histomorphometric results establish CTE as a distinct disorder, separate from FPHL from its outset. Its pathogenic mechanisms are also distinct. These findings support the proposed mechanism of 'immediate telogen release' for CTE, leading to cycle synchronization. For FPHL, accelerated anagen follicular mitotic rates and, thus, higher Ki-67 and VEGF values, would leave less time for differentiation, resulting in hair miniaturization.

Predictors For Weight Loss Failure Following Roux-en-y Gastric Bypass.

Weight loss failure is a widely recognized occurrence following Roux-en-Y gastric bypass. This study aims to identify predictors associated with weight loss failure. It is a retrospective cohort which enrolled 187 subjects who underwent RYGB. Comparisons were made between patients' features at baseline and 24 months after surgery. A weight loss failure rate of 11.2% was found. Advanced age and diabetes were statistically associated with failure. The results found were close to previous reports. As weight loss failure represents an important concern, there is the possibility to perform revisional surgeries, which may emphasize the restrictive or malabsorptive characteristics of RYGB, leading to varied results. It is reinforced that weight loss cannot be used as the unique outcome to evaluate the success of surgery.

In vitro wear resistance of three types of polymethyl methacrylate denture teeth

The wear resistance of denture teeth is important to the longevity of removable prostheses of edentulous patients. The ability of denture teeth to maintain a stable occlusal relationship over time may be influenced by this property. The purpose of this in vitro study was to evaluate the wear resistance of polymethyl methacrylate (PMMA) denture teeth based on their chemical composition when opposed by a ceramic antagonist. The maxillary canines (n=10) of 3 PMMA denture teeth (Trubyte Biotone, cross-linked PMMA; Trilux, highly cross-linked IPN (interpenetrating polymer network)-PMMA; and Vivodent, highly cross-linked PMMA) were secured in an in vitro 2-body wear-testing apparatus that produced sliding contact of the specimens (4.5 cycles/s, sliding distance of 20 mm, under 37°C running water) against glazed or airborne particle abraded ceramic. Wear resistance was measured as height loss (mm) under 300 g (sliding force) after 100,000 cycles, using a digital measuring microscope. Mean values were analyzed by 2-way ANOVA and Tukey's test (a=0.05). The wear of Trubyte Biotone (0.93 ± 0.14 mm) was significantly higher than that of both other types of teeth tested against abraded ceramic (p<0.05). The Vivodent tooth (0.64 ± 0.17 mm) exhibited the best wear resistance among the denture teeth tested against airborne particle abraded ceramic. There were no statistically significant differences (p>0.05) in wear among the 3 denture teeth evaluated against glazed ceramic. Trilux and Vivodent teeth tested against either glazed or airborne particle abraded ceramic did not differ significantly from each other (p<0.05). All teeth showed significantly more wear against airborne particle abraded ceramic than against glazed ceramic (p<0.05). In conclusion, the three types of PMMA denture teeth presented significantly different wear resistance against the abraded ceramic. The high-strength PMMA denture teeth were more wear-resistant than the conventional PMMA denture tooth.