Does less frequent routine monitoring of patients on a stable, fully suppressed cART regimen lead to an increased risk of treatment failure?

OBJECTIVE: To investigate whether HIV-infected patients on a stable and fully suppressive combination antiretroviral therapy (cART) regimen could safely be monitored less often than the current recommendations of every 3 months. DESIGN: Two thousand two hundred and forty patients from the EuroSIDA study who maintained a stable and fully suppressed cART regimen for 1 year were included in the analysis. METHODS: Risk of treatment failure, defined by viral rebound, fall in CD4 cell count, development of new AIDS-defining illness, serious opportunistic infection or death, in the 12 months following a year of a stable and fully suppressed regimen was assessed. RESULTS: One hundred thirty-one (6%) patients experienced treatment failure in the 12 months following a year of stable therapy, viral rebound occurred in 99 (4.6%) patients. After 3, 6 and 12 months, patients had a 0.3% [95% confidence interval (CI) 0.1-0.5], 2.2% (95% CI 1.6-2.8) and 6.0% (95% CI 5.0-7.0) risk of treatment failure, respectively. Patients who spent more than 80% of their time on cART with fully suppressed viraemia prior to baseline had a 38% reduced risk of treatment failure, hazard ratio 0.62 (95% CI 0.42-0.90, P = 0.01). CONCLUSION: Patients who have responded well to cART and are on a well tolerated and durably fully suppressive cART regimen have a low chance of experiencing treatment failure in the next 3-6 months. Therefore, in this subgroup of otherwise healthy patients, it maybe reasonable to extend visit intervals to 6 months, with cost and time savings to both the treating clinics and the patients.

2012 Community Tree Management Plan, Alburnett, IA, June 24, 2013

This plan was developed to assist Alburnett with the management, budgeting and future planning of their urban forest. Across the state, forestry budgets continue to decrease with more and more of that money spent on tree removal. With the anticipated arrival of Emerald Ash Borer (EAB), an invasive pest that kills native ash trees, it is time to prepare for the increased costs of tree removal and replacement planting. With proper planning and management of the current canopy in Alburnett, these costs can be extended over years and public safety issues from dead and dying ash trees mitigated. Trees are an important component of Alburnett’s infrastructure and one of the greatest assets to the community. The benefits of trees are immense. Trees provide the community with improved air quality, stormwater runoff interception, energy conservation, lower traffic speeds, increased property values, reduced crime, improved mental health and create a desirable place to live, to name just a few benefits. It is essential that these benefits be maintained for the people of Alburnett and future generations through good urban forestry management. Good urban forestry management involves setting goals and developing management strategies to achieve these goals. An essential part of developing management strategies is a comprehensive public tree inventory. The inventory supplies information that will be used for maintenance, removal schedules, tree planting and budgeting. Basing actions on this information will help meet Alburnett’s urban forestry goals.

2012 Community Tree Management Plan, Avoca, IA, May 2, 2013

This plan was developed to assist Avoca with the management, budgeting and future planning of their urban forest. Across the state, forestry budgets continue to decrease with more and more of that money spent on tree removal. With the anticipated arrival of Emerald Ash Borer (EAB), an invasive pest that kills native ash trees, it is time to prepare for the increased costs of tree removal and replacement planting. With proper planning and management of the current canopy in Avoca, these costs can be extended over years and public safety issues from dead and dying ash trees mitigated. Trees are an important component of Avoca’s infrastructure and one of the greatest assets to the community. The benefits of trees are immense. Trees provide the community with improved air quality, stormwater runoff interception, energy conservation, lower traffic speeds, increased property values, reduced crime, improved mental health and create a desirable place to live, to name just a few benefits. It is essential that these benefits be maintained for the people of Avoca and future generations through good urban forestry management. Good urban forestry management involves setting goals and developing management strategies to achieve these goals. An essential part of developing management strategies is a comprehensive public tree inventory. The inventory supplies information that will be used for maintenance, removal schedules, tree planting and budgeting. Basing actions on this information will help meet Avoca’s urban forestry goals.

2012 Community Tree Management Plan, Belle Plaine, IA, June 24, 2013

This plan was developed to assist Belle Plaine with the management, budgeting and future planning of their urban forest. Across the state, forestry budgets continue to decrease with more and more of that money spent on tree removal. With the anticipated arrival of Emerald Ash Borer (EAB), an invasive pest that kills native ash trees, it is time to prepare for the increased costs of tree removal and replacement planting. With proper planning and management of the current canopy in Belle Plaine, these costs can be extended over years and public safety issues from dead and dying ash trees mitigated. Trees are an important component of Belle Plaine’s infrastructure and one of the greatest assets to the community. The benefits of trees are immense. Trees provide the community with improved air quality, stormwater runoff interception, energy conservation, lower traffic speeds, increased property values, reduced crime, improved mental health and create a desirable place to live, to name just a few benefits. It is essential that these benefits be maintained for the people of Belle Plaine and future generations through good urban forestry management. Good urban forestry management involves setting goals and developing management strategies to achieve these goals. An essential part of developing management strategies is a comprehensive public tree inventory. The inventory supplies information that will be used for maintenance, removal schedules, tree planting and budgeting. Basing actions on this information will help meet Belle Plaine’s urban forestry goals.

Use of Reversions, 2015 report

The Iowa Department of Transportation spent $488,103 of the FY 2014 RUTF/PRF budget reversion in FY 2015 for desktop consumables, information technology professional services, training and computer equipment.

Visuospatial working memory deficits and visual pursuit impairments are not directly related in schizophrenia.

OBJECTIVE: Patients with schizophrenia show deficits in visuospatial working memory and visual pursuit processes. It is currently unclear, however, whether both impairments are related to a common neuropathological origin. The purpose of the present study was therefore to examine the possible relations between the encoding and the discrimination of dynamic visuospatial stimuli in schizophrenia. METHOD: Sixteen outpatients with schizophrenia and 16 control subjects were asked to encode complex disc displacements presented on a screen. After a delay, participants had to identify the previously presented disc trajectory from a choice of six static linear paths, among which were five incorrect paths. The precision of visual pursuit eye movements during the initial presentation of the dynamic stimulus was assessed. The fixations and scanning time in definite regions of the six paths presented during the discrimination phase were investigated. RESULTS: In comparison with controls, patients showed poorer task performance, reduced pursuit accuracy during incorrect trials and less time scanning the correct stimulus or the incorrect paths approximating its global structure. Patients also spent less time scanning the leftmost portion of the correct path even when making a correct choice. The accuracy of visual pursuit and head movements, however, was not correlated with task performance. CONCLUSIONS: The present study provides direct support for the hypothesis that active integration of visuospatial information within working memory is deficient in schizophrenia. In contrast, a general impairment of oculomotor mechanisms involved in smooth pursuit did not appear to be directly related to lower visuospatial working memory performance in schizophrenia.

Thermostatistical description of small systems in nonequilibrium conditions: Energy conversion and harvesting

Hysteresis cycles are very important features of energy conversion and harvesting devices, such as batteries. The efficiency of these may be strongly affected by the physical size of the system. Here, we show that in systems which are small enough, the existence of physical boundaries which produce nonhomogeneities of the interaction potential gives rise to inflections and barriers in the associated free energy. This in turn brings on irreversible processes which can be triggered under suitable external conditions imposed by a heat bath. As an example, by controlling the temperature, the state of a small system may be impelled to oscillate between two different structural configurations or aggregation states avoiding equilibrium coexistence and therefore dissipating energy. This cyclical behavior associated with a hysteresis cycle may be prototypical of energy conversion, storage, or generating nanodevices, as exemplified by Li-ion insertion batteries.

An international university network for online teaching of pathology in Frenchspeaking countries

Introduction: Building online courses is a highly time consuming task for teachers of a single university. Universities working alone create high-quality courses but often cannot cover all pathological fields. Moreover this often leads to duplication of contents among universities, representing a big waste of teacher time and energy. We initiated in 2011 a French university network for building mutualized online teaching pathology cases, and this network has been extended in 2012 to Quebec and Switzerland. Method: Twenty French universities (see & for details), University Laval in Quebec and University of Lausanne in Switzerland are associated to this project. One e-learning Moodle platform (http://moodle.sorbonne-paris-cite.fr/) contains texts with URL pointing toward virtual slides that are decentralized in several universities. Each university has the responsibility of its own slide scanning, slide storage and online display with virtual slide viewers. The Moodle website is hosted by PRES Sorbonne Paris Cité, and financial supports for hardware have been obtained from UNF3S (http://www.unf3s.org/) and from PRES Sorbonne Paris Cité. Financial support for international fellowships has been obtained from CFQCU (http://www.cfqcu.org/). Results: The Moodle interface has been explained to pathology teachers using web-based conferences with screen sharing. The teachers added then contents such as clinical cases, selfevaluations and other media organized in several sections by student levels and pathological fields. Contents can be used as online learning or online preparation of subsequent courses in classrooms. In autumn 2013, one resident from Quebec spent 6 weeks in France and Switzerland and created original contents in inflammatory skin pathology. These contents are currently being validated by senior teachers and will be opened to pathology residents in spring 2014. All contents of the website can be accessed for free. Most contents just require anonymous connection but some specific fields, especially those containing pictures obtained from patients who agreed for a teaching use only, require personal identification of the students. Also, students have to register to access Moodle tests. All contents are written in French but one case has been translated into English to illustrate this communication (http://moodle.sorbonne-pariscite.fr/mod/page/view.php?id=261) (use "login as a guest"). The Moodle test module allows many types of shared questions, making it easy to create personalized tests. Contents that are opened to students have been validated by an editorial committee composed of colleagues from the participating institutions. Conclusions: Future developments include other international fellowships, the next one being scheduled for one French resident from May to October 2014 in Quebec, with a study program centered on lung and breast pathology. It must be kept in mind that these e-learning programs highly depend on teachers' time, not only at these early steps but also later to update the contents. We believe that funding resident fellowships for developing online pathological teaching contents is a win-win situation, highly beneficial for the resident who will improve his knowledge and way of thinking, highly beneficial for the teachers who will less worry about access rights or image formats, and finally highly beneficial for the students who will get courses fully adapted to their practice.

1245-02IJ West Tarkio Final Report

Initiated in 2001, the West Tarkio Creek Watershed Project has a proven track record of implementing an enormous amount of structural conservation practices. To date, over $925,000 has been spent to build 69 miles of terraces on 63 cooperators' land. The success of the Project was due in large part to the conservation ethic of the landowners to improve their farms, preserve the productivity of the land, and protect West Tarkio Creek. This has been made possible through funding from DSC Watershed Protection Funds (WSPF) which has provided $1,362,592 in cost share funds since 2001 but is has been severely limited in recent years due to shortages within the State’s budget. The original project goals called for the construction of 750,000 feet (142 miles) of terraces to effectively treat the watershed. In order to meet these goals and bring the project to a successful endpoint, another 153,000 feet (29 miles) remain to be constructed by the landowners with the help of the SWCD staff. Severe rain events in recent years have caused an enormous amount of damage throughout the region, these storms were helpful in identifying where watershed work remains to be completed. Scars on the landscape in the aftermath of the storms clearly etched out the specific location where additional practices are needed in addition to those proposed in the original project work plan. Project supporters are confident that the WIRB Program can unlock this potential and pave the way for what can become known as one of the most effective land treatment projects in Iowa.

1118-007 Lake Hendricks Watershed Final Report

Lake Hendricks is a 54 acre man-made lake that is encompassed by a 1,209 acre watershed. Lake Hendricks is currently on the 303(d) Impaired Waters List for algae and pH impairments due to an abundance of algae growth caused by nutrients being delivered to the lake via 11 separate tile lines draining adjoining cropland areas. In 2009, a Watershed Management Plan was developed in partnership with IDALS and the IDNR 319 programs and $256,500 was awarded to address the nutrient and sediment loading of the lake. Over the past three years a total of $251,000 were spent to implement one grade stabilization structure, two sediment basins, two bioreactors, 700 feet of streambank stabilization, 30.7 acres oftimber stand improvement, and 39.4 acres of Conservation Reserve Program (CRP). A proposed wetland structure and three sediment basins are scheduled to be constructed in the fall of 2011. Current water monitoring data is showing an average of 54% Nitrate (N) loading reductions as a result of the installed BMPs. The District feels further reductions are possible by addressing nutrient management issues in the cropland areas, stabilizing additional streambanks, and improving the surrounding woodland areas. The goal is to reduce N loading by an additional 20% and sediment loading by 50 tlac/yr. The resulting collaborative effort may lead to the future de-listing of Lake Hendricks from the 303(d) Impaired Waters List.

07032-012 Lake MacBride Watershed Final Report

Lake Macbride is considered to be one of the top four lakes for fishing in the state of Iowa. It is widely used by the public and contributes significant economic benefits to the county. Lake Macbride is situated in the North Corridor which is one of the fastest growing areas in the state. The lake has a surface area of 940 acres and drains 16,205 acres. Lake Macbride is on the Iowa 303(d) list for excessive sediments and nutrients. In 2001, Lake Macbride State Park received over 2.5 million dollars from the Marine Fuel Tax and Fish and Wildlife Trust to install 2 silt basins and stabilize over 12 miles of shoreline in the lake. Also in 2001, the Johnson County SWCD received a WSPF allocation from DSC to address agriculture and urban runoff issues in the watershed. Section 319 funding was received in 2002 to continue watershed efforts to the present. A watershed assessment was completed in 2003 to guide watershed activities. In 2005, a TMDL was completed for the lake. Since 2001, over $645,000 dollars has been spent by landowners and funding partners to install conservation practices in the watershed. Watershed efforts have resulted in the reduction of over 4200 tons of soils from being delivered into Lake Macbride. Nutrient reductions have also occurred from the development of nutrient management plans on 2000 acres. The District is in the process of wrapping up watershed efforts on private land. A series of 13 structures is planned to be installed in the State Park over the next several years. One of the last remaining items that still needs addressed is 1,400 feet of eroding shoreline adjacent to Lake Macbride along Cottage Reserve Road. The road is under the jurisdiction of the Johnson County Board of Supervisors. Both the Board of Supervisors and the IDNR are willing to contribute substantial dollars to address the 250 tons of soil that are being directly delivered to Lake Macbride each year.

A mixed ecologic-cohort comparison of physical activity & weight among young adults from five populations of African origin.

BACKGROUND: Examination of patterns and intensity of physical activity (PA) across cultures where obesity prevalence varies widely provides insight into one aspect of the ongoing epidemiologic transition. The primary hypothesis being addressed is whether low levels of PA are associated with excess weight and adiposity. METHODS: We recruited young adults from five countries (500 per country, 2500 total, ages 25-45 years), spanning the range of obesity prevalence. Men and women were recruited from a suburb of Chicago, Illinois, USA; urban Jamaica; rural Ghana; peri-urban South Africa; and the Seychelles. PA was measured using accelerometry and expressed as minutes per day of moderate-to-vigorous activity or sedentary behavior. RESULTS: Obesity (BMI ≥ 30) prevalence ranged from 1.4% (Ghanaian men) to 63.8% (US women). South African men were the most active, followed by Ghanaian men. Relatively small differences were observed across sites among women; however, women in Ghana accumulated the most activity. Within site-gender sub-groups, the correlation of activity with BMI and other measures of adiposity was inconsistent; the combined correlation across sites was -0.17 for men and -0.11 for women. In the ecological analysis time spent in moderate-to-vigorous activity was inversely associated with BMI (r = -0.71). CONCLUSION: These analyses suggest that persons with greater adiposity tend to engage in less PA, although the associations are weak and the direction of causality cannot be inferred because measurements are cross-sectional. Longitudinal data will be required to elucidate direction of association.

Reduced cardiorespiratory fitness, low physical activity and an urban environment are independently associated with increased cardiovascular risk in children.

AIMS/HYPOTHESIS: To assist in the development of preventive strategies, we studied whether the neighbourhood environment or modifiable behavioural parameters, including cardiorespiratory fitness (CRF) and physical activity (PA), are independently associated with obesity and metabolic risk markers in children. METHODS: We carried out a cross-sectional analysis of 502 randomly selected first and fifth grade urban and rural Swiss schoolchildren with regard to CRF, PA and the neighbourhood (rural vs urban) environment. Outcome measures included BMI, sum of four skinfold thicknesses, homeostasis model assessment of insulin resistance (HOMA-IR) and a standardised clustered metabolic risk score. RESULTS: CRF and PA (especially total PA, but also the time spent engaged in light and in moderate and vigorous intensity PA) were inversely associated with measures of obesity, HOMA-IR and the metabolic risk score, independently of each other, and of sociodemographic and nutritional parameters, media use, sleep duration, BMI and the neighbourhood environment (all p < 0.05). Children living in a rural environment were more physically active and had higher CRF values and reduced HOMA-IR and metabolic risk scores compared with children living in an urban environment (all p < 0.05). These differences in cardiovascular risk factors persisted after adjustment for CRF, total PA and BMI. CONCLUSIONS/INTERPRETATION: Reduced CRF, low PA and an urban environment are independently associated with an increase in metabolic risk markers in children.

Septal lesions impair the acquisition of a cued place navigation task: attentional or memory deficit?

These experiments were designed to analyze how medial septal lesions reducing the cholinergic innervation in the hippocampus might affect place learning. Rats with quisqualic lesions of the medial septal area (MS) were trained in a water maze and on a homing table where the escape position was located at a spatially fixed position and further indicated by a salient cue suspended above it. The lesioned rats were significantly impaired in reaching the cued escape platform during training. In addition rats, did not show any discrimination of the training sector during a probe trial in which no platform or cue was present. This impairment remained significant during further training in the absence of the cue. When the cued escape platform was located at an unpredictable spatial location, the MS-lesioned rats showed no deficit and spent more time under the cue than control rats during the probe trial. On the homing board, with a salient object in close proximity to the escape hole, the MS rats showed no deficit in escape latencies, although a significant reduction in spatial memory was observed. However, this was overcome by additional training in the absence of the cue. Under these conditions, rats with septal lesions were prone to develop a pure guidance strategy, whereas normal rats combined a guidance strategy with a memory of the escape position relative to more distant landmarks. The presence of a salient cue appeared to decrease attention to environmental landmarks, thus reducing spatial memory. These data confirm the general hypothesis that MS lesions reduce the capacity to rely on a representation of the relation between several landmarks with different salience.

Online teaching of inflammatory skin pathology by a French-speaking International University Network.

INTRODUCTION: Developments in technology, web-based teaching and whole slide imaging have broadened the teaching horizon in anatomic pathology. Creating online learning material including many types of media such as radiologic images, whole slides, videos, clinical and macroscopic photographs, is now accessible to most universities. Unfortunately, a major limiting factor to maintain and update the learning material is the amount of resources needed. In this perspective, a French-national university network was initiated in 2011 to build joint online teaching modules consisting of clinical cases and tests. The network has since expanded internationally to Québec, Switzerland and Ivory Coast. METHOD: One of the first steps of the project was to build a learning module on inflammatory skin pathology for interns and residents in pathology and dermatology. A pathology resident from Québec spent 6 weeks in France and Switzerland to develop the contents and build the module on an e-learning Moodle platform under the supervision of two dermatopathologists. The learning module contains text, interactive clinical cases, tests with feedback, virtual slides, images and clinical photographs. For that module, the virtual slides are decentralized in 2 universities (Bordeaux and Paris 7). Each university is responsible of its own slide scanning, image storage and online display with virtual slide viewers. RESULTS: The module on inflammatory skin pathology includes more than 50 web pages with French original content, tests and clinical cases, links to over 45 virtual images and more than 50 microscopic and clinical photographs. The whole learning module is being revised by four dermatopathologists and two senior pathologists. It will be accessible to interns and residents in the spring of 2014. The experience and knowledge gained from that work will be transferred to the next international resident whose work will be aimed at creating lung and breast pathology learning modules. CONCLUSION: The challenges of sustaining a project of this scope are numerous. The technical aspect of whole-slide imaging and storage needs to be developed by each university or group. The content needs to be regularly updated and its accuracy reviewed by experts in each individual domain. The learning modules also need to be promoted within the academic community to ensure maximal benefit for trainees. A collateral benefit of the project was the establishment of international partnerships between French-speaking universities and pathologists with the common goal of promoting pathology education through the use of multi-media technology including whole slide imaging.