The influence of neurocognitive impairment, alcohol and other drug (AOD) use, and psychosocial factors on antiretroviral treatment adherence, service utilization and viral load among HIV-seropositive adults

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p<0.01) at 6 months, but not 3 months, post-intervention. Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.

Molecular characterization of extended-spectrum cephalosporin-resistance in Escherichia coli in pigs on-farm and from clinical cases throughout Quebec, Canada during 16 years

Le développement de la multirésistance chez Escherichia coli est un problème important en médecine animale et humaine. En outre, l’émergence et la diffusion des déterminants de résistance aux céphalosporines à larges spectres de troisième génération (ESCs) parmi les isolats, incluant des céphalosporines essentielles en médecine humaine (ex. ceftriaxone et ceftiofur), est un problème majeur de santé publique. Cette thèse visait trois objectifs. D’abord étudier la dynamique de la résistance aux antimicrobiens (AMR) ainsi que la virulence et les profils génétiques de la AMR des E. coli isolées de porcs recevant une nourriture post-sevrage supplémentée avec de la chlortétracycline et de la pénicilline G, et, accessoirement, évaluer les effets d'additifs alimentaires sur cette dynamique en prenant pour exemple d'étude un minéral argileux, la clinoptilolite, étant donné son possible lien avec le gène blaCMY-2 qui confère la résistance au ceftiofur. L'objectif suivant était d'investiguer les mécanismes menant à une augmentation de la prévalence du gène blaCMY-2 chez les porcs qui reçoivent de la nourriture médicamentée et qui n'ont pas été exposés au ceftiofur Ici encore,nous avons examiné les effets d’un supplément alimentaire avec un minéral argileux sur ce phénomène. Enfin, notre dernier objectif était d’étudier, dans le temps, les génotypes des isolats cliniques d'E. coli résistant au ceftiofur, isolés de porcs malades au Québec à partir du moment où la résistance au ceftiofur a été rapportée, soit de 1997 jusqu'à 2012. Dans l'étude initiale, la prévalence de la résistance à 10 agents antimicrobiens, incluant le ceftiofur, s’accroît avec le temps chez les E.coli isolées de porcelets sevrés. Une augmentation tardive de la fréquence du gène blaCMY-2, encodant pour la résistance au ceftiofur, et la présence des gènes de virulence iucD et tsh a été observée chez les isolats. La nourriture supplémentée avec de la clinoptilolite a été associée à une augmentation rapide mais, par la suite, à une diminution de la fréquence des gènes blaCMY-2 dans les isolats. En parallèle, une augmentation tardive dans la fréquence des gènes blaCMY-2 et des gènes de virulence iucD et tsh a été observée dans les isolats des porcs contrôles, étant significativement plus élevé que dans les porcs ayant reçu l'additif au jour 28. La diversité, au sein des E. coli positives pour blaCMY-2 , a été observée au regard des profils AMR. Certaines lignées clonales d'E.coli sont devenues prédominantes avec le temps. La lignée clonale du phylotype A prédominait dans le groupe supplémenté, alors que les lignées clonales du phylotype B1, qui possèdent souvent le gène de virulence iucD associé aux ExPEC, prédominaient dans le groupe contrôle. Les plasmides d'incompatibilité (Inc) des groupes, I1, A/C, et ColE, porteurs de blaCMY-2, ont été observés dans les transformants. Parmi les souches cliniques d'E.coli ESC-résistantes, isolées de porcs malades au Québec de 1997 à 2012, blaCMY-2 était le gène codant pour une β-lactamase le plus fréquemment détecté; suivi par blaTEM et blaCTX-M,. De plus, les analyses clonales montrent une grande diversité génétique. Par contre, des isolats d'E. coli avec des profils PFGE identiques ont été retrouvés dans de multiples fermes la même année mais aussi dans des années différentes. La résistance à la gentamicine, kanamycine, chloramphenicol, et la fréquence de blaTEM et de IncA/C diminuent significativement au cour de la période étudiée, alors que la fréquence de IncI1 et de la multirésistance à sept catégories d'agents antimicrobiens augmente significativement avec le temps. L'émergence d'isolats d'E. coli positifs pour blaCTX-M, une β-lactamase à large spectre et produisant des ESBL, a été observée en 2011 et 2012 à partir de lignées clonales distinctes et chez de nombreuses fermes. Ces résultats, mis ensemble, apportent des précisions sur la dissémination de la résistance au ceftiofur dans les E. coli isolées de porcs. Au sein des échantillons prélevés chez les porcs sevrés recevant l'alimentation médicamentée sur une ferme, et pour laquelle une augmentation de la résistance au ceftiofur a été observée, les données révèlent que les souches d'E. coli positives pour blaCMY-2 et résistantes aux ESCs appartenaient à plusieurs lignées clonales différentes arborant divers profils AMR. Le gène blaCMY-2 se répand à la fois horizontalement et clonalement chez ces E. coli. L'ajout de clinoptilotite à la nourriture et le temps après le sevrage influencent la clonalité et la prévalence du gène blaCMY-2 dans les E. coli. Durant les 16 années d'étude, plusieurs lignées clonales différentes ont été observées parmi les souches d'E. coli résistantes au ceftiofur isolées de porc malades de fermes québécoises, bien qu’aucune lignée n'était persistante ou prédominante pendant l'étude. Les résultats suggèrent aussi que le gène blaCMY-2 s'est répandu à la fois horizontalement et clonalement au sein des fermes. De plus, blaCMY-2 est le gène majeur des β-lactamases chez ces isolats. À partir de 2011, nous rapportons l'émergence du gène blaCTX-M dans des lignées génétiques distinctes.

Using Information, Metrics and Developing Business Cases for L&D

The second theme of this book concerns L&D’s ‘Contributions’, specifically how L&D professionals articulate, communicate and demonstrate value that it brings to the organization. Specifically, Chapter 3, titled ‘Using information, metrics and developing business cases for L&D’, discusses how L&D professionals can do this using the business case as a vehicle. The business case is a tool that L&D professionals can use to show how new L&D initiatives can benefit the organization and its stakeholders. The value of such benefit can be ‘articulated’ quantitatively and qualitatively. Chapter 3 adopts a holistic approach in developing a business case. L&D professionals must be competently knowledgeable about accounting and finance but without the need to be experts – as their expertise lies in L&D. Therefore to successfully complete a business case, L&D professionals need to form teams comprising the right members (depending on what the business case is about). The political realities that are associated with the development of a business case can be important considerations. How well L&D is able to ‘sell’ a business case depends on how well it is framed, usually either as a problem or opportunity. We then discuss the information, data and metrics required to build a typical business case, specifically in terms of identifying the benefits and costs. The chapter concludes with some suggestions on how the findings from the business case can be presented in infographics-inspired form.

Online marketing internationally: Bizpartner and the parallel cases of Portugal and Greece

This report is the result of the curricular internship carried out in Bizpartner, a company from Slovakia, for the Master’s degree in Languages and Business Relations. The objective of this report is to present the activities developed during the internship, as well as a brief study of how Bizpartner internationalizes and the different results obtained from Portugal, Greece and the United Kingdom. There is a contextualization of Slovakia, Bizpartner and Internationalization, followed by the specific cases of Portugal, Greece and the United Kingdom. Finally, there is a reflection on all the work done, attempting to relate the internship with the knowledge acquired during the course.

The concept of low glycemic index and glycemic load foods as panacea for type 2 diabetes mellitus; prospects, challenges and solutions.

Background: This article examines the concepts of low glycemic indices (GIs) and glycemic load (GL) foods as key drivers in the dietary management of type 2 diabetes as well as their shortcomings. The controversies arising from the analysis of glycemic index (GI) and GL of foods such as their reproducibility as well as their relevance to the dietary management of type 2 diabetes are also discussed. Methods: Search was conducted in relevant electronic databases such as: Pubmed, Google Scholar, HINARI, the Cochrane library, Popline, LILACS, CINAHL, EMBASE, etc to identify the current status of knowledge regarding the controversies surrounding management of diabetes with low GI and GL foods. Conclusion: This article suggests that in view of discrepancies that surround the results of GI versus GL of foods, any assay on the GI and GL of a food with the aim of recommending the food for the dietary management of type 2 diabetes, could be balanced with glycated hemoglobin assays before they are adopted as useful antidiabetic foods.

Molecular characterization of extended-spectrum cephalosporin-resistance in Escherichia coli in pigs on-farm and from clinical cases throughout Quebec, Canada during 16 years

Le développement de la multirésistance chez Escherichia coli est un problème important en médecine animale et humaine. En outre, l’émergence et la diffusion des déterminants de résistance aux céphalosporines à larges spectres de troisième génération (ESCs) parmi les isolats, incluant des céphalosporines essentielles en médecine humaine (ex. ceftriaxone et ceftiofur), est un problème majeur de santé publique. Cette thèse visait trois objectifs. D’abord étudier la dynamique de la résistance aux antimicrobiens (AMR) ainsi que la virulence et les profils génétiques de la AMR des E. coli isolées de porcs recevant une nourriture post-sevrage supplémentée avec de la chlortétracycline et de la pénicilline G, et, accessoirement, évaluer les effets d'additifs alimentaires sur cette dynamique en prenant pour exemple d'étude un minéral argileux, la clinoptilolite, étant donné son possible lien avec le gène blaCMY-2 qui confère la résistance au ceftiofur. L'objectif suivant était d'investiguer les mécanismes menant à une augmentation de la prévalence du gène blaCMY-2 chez les porcs qui reçoivent de la nourriture médicamentée et qui n'ont pas été exposés au ceftiofur Ici encore,nous avons examiné les effets d’un supplément alimentaire avec un minéral argileux sur ce phénomène. Enfin, notre dernier objectif était d’étudier, dans le temps, les génotypes des isolats cliniques d'E. coli résistant au ceftiofur, isolés de porcs malades au Québec à partir du moment où la résistance au ceftiofur a été rapportée, soit de 1997 jusqu'à 2012. Dans l'étude initiale, la prévalence de la résistance à 10 agents antimicrobiens, incluant le ceftiofur, s’accroît avec le temps chez les E.coli isolées de porcelets sevrés. Une augmentation tardive de la fréquence du gène blaCMY-2, encodant pour la résistance au ceftiofur, et la présence des gènes de virulence iucD et tsh a été observée chez les isolats. La nourriture supplémentée avec de la clinoptilolite a été associée à une augmentation rapide mais, par la suite, à une diminution de la fréquence des gènes blaCMY-2 dans les isolats. En parallèle, une augmentation tardive dans la fréquence des gènes blaCMY-2 et des gènes de virulence iucD et tsh a été observée dans les isolats des porcs contrôles, étant significativement plus élevé que dans les porcs ayant reçu l'additif au jour 28. La diversité, au sein des E. coli positives pour blaCMY-2 , a été observée au regard des profils AMR. Certaines lignées clonales d'E.coli sont devenues prédominantes avec le temps. La lignée clonale du phylotype A prédominait dans le groupe supplémenté, alors que les lignées clonales du phylotype B1, qui possèdent souvent le gène de virulence iucD associé aux ExPEC, prédominaient dans le groupe contrôle. Les plasmides d'incompatibilité (Inc) des groupes, I1, A/C, et ColE, porteurs de blaCMY-2, ont été observés dans les transformants. Parmi les souches cliniques d'E.coli ESC-résistantes, isolées de porcs malades au Québec de 1997 à 2012, blaCMY-2 était le gène codant pour une β-lactamase le plus fréquemment détecté; suivi par blaTEM et blaCTX-M,. De plus, les analyses clonales montrent une grande diversité génétique. Par contre, des isolats d'E. coli avec des profils PFGE identiques ont été retrouvés dans de multiples fermes la même année mais aussi dans des années différentes. La résistance à la gentamicine, kanamycine, chloramphenicol, et la fréquence de blaTEM et de IncA/C diminuent significativement au cour de la période étudiée, alors que la fréquence de IncI1 et de la multirésistance à sept catégories d'agents antimicrobiens augmente significativement avec le temps. L'émergence d'isolats d'E. coli positifs pour blaCTX-M, une β-lactamase à large spectre et produisant des ESBL, a été observée en 2011 et 2012 à partir de lignées clonales distinctes et chez de nombreuses fermes. Ces résultats, mis ensemble, apportent des précisions sur la dissémination de la résistance au ceftiofur dans les E. coli isolées de porcs. Au sein des échantillons prélevés chez les porcs sevrés recevant l'alimentation médicamentée sur une ferme, et pour laquelle une augmentation de la résistance au ceftiofur a été observée, les données révèlent que les souches d'E. coli positives pour blaCMY-2 et résistantes aux ESCs appartenaient à plusieurs lignées clonales différentes arborant divers profils AMR. Le gène blaCMY-2 se répand à la fois horizontalement et clonalement chez ces E. coli. L'ajout de clinoptilotite à la nourriture et le temps après le sevrage influencent la clonalité et la prévalence du gène blaCMY-2 dans les E. coli. Durant les 16 années d'étude, plusieurs lignées clonales différentes ont été observées parmi les souches d'E. coli résistantes au ceftiofur isolées de porc malades de fermes québécoises, bien qu’aucune lignée n'était persistante ou prédominante pendant l'étude. Les résultats suggèrent aussi que le gène blaCMY-2 s'est répandu à la fois horizontalement et clonalement au sein des fermes. De plus, blaCMY-2 est le gène majeur des β-lactamases chez ces isolats. À partir de 2011, nous rapportons l'émergence du gène blaCTX-M dans des lignées génétiques distinctes.

The relationship between cranial structure, biomechanical performance and ecological diversity in varanoid lizards

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Skull structure is intimately associated with feeding ability in vertebrates, both in terms of specific performance measures and general ecological characteristics. This study quantitatively assessed variation in the shape of the cranium and mandible in varanoid lizards, and its relationship to structural performance (von Mises strain) and interspecific differences in feeding ecology. Geometric morphometric and linear morphometric analyses were used to evaluate morphological differences, and finite element analysis was used to quantify variation in structural performance (strain during simulated biting, shaking and pulling). This data was then integrated with ecological classes compiled from relevant scientific literature on each species in order to establish structure-function relationships. Finite element modelling results showed that variation in cranial morphology resulted in large differences in the magnitudes and locations of strain in biting, shaking and pulling load cases. Gracile species such as Varanus salvadorii displayed high strain levels during shaking, especially in the areas between the orbits. All models exhibit less strain during pull back loading compared to shake loading, even though a larger force was applied (pull =30N, shake = 20N). Relationships were identified between the morphology, performance, and ecology. Species that did not feed on hard prey clustered in the gracile region of cranial morphospace and exhibited significantly higher levels of strain during biting (P = 0.0106). Species that fed on large prey clustered in the elongate area of mandible morphospace. This relationship differs from those that have been identified in other taxonomic groups such as crocodiles and mammals. This difference may be due to a combination of the open 'space-frame' structure of the varanoid lizard skull, and the 'pull back' behaviour that some species use for processing large prey.

The Influence of Neurocognitive Impairment, Alcohol and other Drug (AOD) Use, and Psychosocial Factors on Antiretroviral Treatment Adherence, Service Utilization and Viral Load Among HIV-Seropositive Adults

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.

Effect of constitutive material models on seismic response of two-story reinforced concrete frame

This paper focuses on the finite element (FE) response sensitivity and reliability analyses considering smooth constitutive material models. A reinforced concrete frame is modeled for FE sensitivity analysis followed by direct differentiation method under both static and dynamic load cases. Later, the reliability analysis is performed to predict the seismic behavior of the frame. Displacement sensitivity discontinuities are observed along the pseudo-time axis using non-smooth concrete and reinforcing steel model under quasi-static loading. However, the smooth materials show continuity in response sensitivity at elastic to plastic transition points. The normalized sensitivity results are also used to measure the relative importance of the material parameters on the structural responses. In FE reliability analysis, the influence of smoothness behavior of reinforcing steel is carefully noticed. More efficient and reasonable reliability estimation can be achieved by using smooth material model compare with bilinear material constitutive model.

An analytical study of the low frequency structural responses of a submerged hull

This paper studies the low frequency vibrational behaviour of a submerged hull. The submerged hull is modelled as a finite fluid-loaded cylindrical shell closed at each end by circular plates. The external pressure acting on the hull due to the fluid loading is analytically calculated using an infinite model. Three excitation cases of the hull are considered. In the first model, an axial point force is applied at the centre of one end plate, giving rise to an axisymmetric case in which only the zeroth circumferential shell modes are excited. In the second model, an axial point force is applied at the edge of the end plate. In the third model, a radial point force is applied also at the edge of the end plate. In the second and third load cases, all cylindrical shell circumferential modes are excited. The effects of fluid loading and different excitation locations are studied. A more complex hull model including stiffeners and bulkheads is then examined. A smeared approach is used to analytically model the ring stiffeners. All load cases are again considered and the effects of the various influencing factors on the low frequency responses are described.

Topology Optimization of continuum structures with epsilon-relaxed stress constraints

Topology optimization of linear elastic continuum structures is a challenging problem when considering local stress constraints. The reasons are the singular behavior of the constraint with the density design variables, combined with the large number of constraints even for small finite element meshes. This work presents an alternative formulation for the s-relaxation technique, which provides an workaround for the singularity of the stress constraint. It also presents a new global stress constraint formulation. Derivation of the sensitivities for the constraint by the adjoint method is shown. Results for single and multiple load cases show the potential of the new formulation.

A Linear S-N Curve with Load Dependent Variance and Explicit Failure Probability

We reconsider standard uniaxial fatigue test data obtained from handbooks. Many S-N curve fits to such data represent the median life and exclude load-dependent variance in life. Presently available approaches for incorporating probabilistic aspects explicitly within the S-N curves have some shortcomings, which we discuss. We propose a new linear S-N fit with a prespecified failure probability, load-dependent variance, and reasonable behavior at extreme loads. We fit our parameters using maximum likelihood, show the reasonableness of the fit using Q-Q plots, and obtain standard error estimates via Monte Carlo simulations. The proposed fitting method may be used for obtaining S-N curves from the same data as already available, with the same mathematical form, but in cases in which the failure probability is smaller, say, 10 % instead of 50 %, and in which the fitted line is not parallel to the 50 % (median) line.

Assessment of Speech Dialog Systems using Multi-Modal Cognitive Load Analysis and Driving Performance Metrics

In this paper, cognitive load analysis via acoustic- and CAN-Bus-based driver performance metrics is employed to assess two different commercial speech dialog systems (SDS) during in-vehicle use. Several metrics are proposed to measure increases in stress, distraction and cognitive load and we compare these measures with statistical analysis of the speech recognition component of each SDS. It is found that care must be taken when designing an SDS as it may increase cognitive load which can be observed through increased speech response delay (SRD), changes in speech production due to negative emotion towards the SDS, and decreased driving performance on lateral control tasks. From this study, guidelines are presented for designing systems which are to be used in vehicular environments.

Load sharing and power quality enhanced operation of a distributed microgrid

This paper describes control methods for proper load sharing between parallel converters connected in a microgrid and supplied by distributed generators (DGs). It is assumed that the microgrid spans a large area and it supplies loads in both in grid connected and islanded modes. A control strategy is proposed to improve power quality and proper load sharing in both islanded and grid connected modes. It is assumed that each of the DGs has a local load connected to it which can be unbalanced and/or nonlinear. The DGs compensate the effects of unbalance and nonlinearity of the local loads. Common loads are also connected to the microgrid, which are supplied by the utility grid under normal conditions. However during islanding, each of the DGs supplies its local load and shares the common load through droop characteristics. Both impedance and motor loads are considered to verify the system response. The efficacy of the controller has been validated through simulation for various operating conditions using PSCAD. It has been found through simulation that the total Harmonic Distortion (THD) of the of the microgrid voltage is about 10% and the negative and zero sequence component are around 20% of the positive sequence component before compensation. After compensation, the THD remain below 0.5%, whereas, negative and zero sequence components of the voltages remain below 0.02% of the positive sequence component.

Journalism Ethics : Arguments and Cases

Hirst and Patching's second edition of Journalism Ethics: Arguments and Cases provides a fully updated exploration of the theory and practice of ethics in journalism. The authors situate modern ethical dilemmas in their social and historical context, which encourages students to think critically about ethics across the study and practice of journalism. Using a unique political economy approach, the text provides students with a theoretical and philosophical understanding of the major ethical dilemmas in journalism today. It commences with a newly recast discussion of theoretical frameworks, which explains the complex concepts of ethics in clear and comprehensive terms. It then examines the 'fault lines' in modern journalism, such as the constant conflict between the public service role of the media, and a journalist's commercial imperative to make a profit. All chapters have been updated with new examples, and many new cases demonstrating the book's theoretical underpinnings have been drawn from 'yesterday's headlines'. These familiar cases encourage student engagement and classroom discussion, and archived cases will still be available to students on an Online Resource Centre. Expanded coverage of the 'War on Terror', issues of deception within journalism, and infotainment and digital technology is included.