This research sought to assess whether and how patient preference (PP) data are currently used within health technology assessment (HTA) bodies and affiliated organizations involved in technology/drug appraisals and assessments. An exploratory survey was developed by the PP Project Subcommittee of the HTA International Patient and Citizen Involvement Interest Group to gain insight into the use, impact, and role of PP data in HTA, as well as the perceived barriers to its incorporation. Forty members of HTA bodies and affiliated organizations from twelve countries completed the online survey. PP data were reported to be formally considered as part of the HTA evidence review process by 82.5 percent of the respondents, while 39.4 percent reported that most of the appraisals and assessments within their organization in the past year had submitted PP data. The leading reason for why PP data were not submitted in most assessments was time/resource constraints followed by lack of clarity on PP data impact. Participants reported that PP data had a moderate level of influence on the deliberative process and outcome of the decision, but a higher level of influence on the decision’s quality. Most (81.8 percent) felt patient advocacy groups should be primarily responsible for generating and submitting this type of evidence. Insights from the survey confirm the use of PP data in HTA but reveal barriers to its broader and more meaningful integration. Encouragingly, participants believe obstacles can be overcome, paving the way for a second phase of research involving in-depth collaborative workshops with HTA representatives.

The Bronze Age in Britain is now a term often used to include both the first use of copper c. 2400 bc and also tin-bronze from c. 2100 bc, all of which required the extensive use of copper. Prehistoric mining for this metal has been identified in surface and underground workings in Parys Mine, Mynydd Parys, Anglesey, although almost all of the surface workings are now obscured by the extensive deep spoil from more recent mining in the industrial period. These copper-bearing ores are in bedded lodes, together with some intruded vein deposits. The Bronze Age workings have been exposed underground where they have been intersected by the early 19th century industrial workings on and above the 16 fathom and 20 fathom levels in the Parys Mine. Spoil exposures contain stone hammers (‘mauls’), wood fragments, and charcoal; samples of the latter have been radiocarbon dated with chronological modelling suggesting activity took place in the first half of the 2nd millennium cal bc. Although relatively limited in extent, these important prehistoric mining sites are among the earliest found in the UK. They have survived due to their protection from surface erosion and limited accessibility.

ABSTRACT IMPACT: This work seeks to improve the diagnostic accuracy of urinary tract infection among hospitalized older adults and mitigate antibiotic overuse in this population. OBJECTIVES/GOALS: Primary objective: To determine the diagnostic accuracy of serum procalcitonin (PCT) for the diagnosis of symptomatic urinary tract infection (UTI) in hospitalized older adults. Secondary objectives: (1) To develop a predictive model for the diagnosis of UTI; (2) To determine the ability of PCT in discriminating between lower and upper UTI. METHODS/STUDY POPULATION: We performed a prospective observational cohort study of 228 participants from a single institution. The study population included older adults (age 65 or older) who were hospitalized on the general medicine wards with a possible or suspected urinary tract infection (UTI). Upon obtaining informed consent, serum procalcitonin (PCT) was processed on remnant blood samples collected from the emergency department. We performed additional data collection through the electronic health record to obtain demographic information, clinical characteristics, and other laboratory and imaging results. Clinicians were surveyed for the diagnosis of UTI and charts were adjudicated by independent reviews of the medical record by infectious diseases experts to determine the primary endpoint of symptomatic UTI. RESULTS/ANTICIPATED RESULTS: We anticipate that serum procalcitonin predicts the presence of symptomatic urinary tract infection (UTI) by demonstrating an area under the receiver operating characteristic curve of at least 0.85. A predictive model developed in our cohort for the diagnosis of symptomatic UTI will be improved by the addition of serum PCT to the prediction model. Finally, we anticipate the serum PCT will accurately discriminate between upper and lower UTI. DISCUSSION/SIGNIFICANCE OF FINDINGS: Diagnosis of symptomatic UTI in hospitalized older adults is challenging and may lead to overuse of antibiotics and the development of antibiotic resistance in this vulnerable patient population. Serum procalcitonin offers a novel diagnostic strategy in the diagnosis of symptomatic UTI to enable more appropriate antibiotic therapy.

New guidelines for peanut allergy prevention in high-risk infants recommend introducing peanut during infancy but do not address breastfeeding or maternal peanut consumption. We assessed the independent and combined association of these factors with peanut sensitization in the general population CHILD birth cohort (N = 2759 mother–child dyads). Mothers reported peanut consumption during pregnancy, timing of first infant peanut consumption, and length of breastfeeding duration. Child peanut sensitization was determined by skin prick testing at 1, 3, and 5 years. Overall, 69% of mothers regularly consumed peanuts and 36% of infants were fed peanut in the first year (20% while breastfeeding and 16% after breastfeeding cessation). Infants who were introduced to peanut early (before 1 year) after breastfeeding cessation had a 66% reduced risk of sensitization at 5 years compared to those who were not (1.9% vs. 5.8% sensitization; aOR 0.34, 95% CI 0.14–0.68). This risk was further reduced if mothers introduced peanut early while breastfeeding and regularly consumed peanut themselves (0.3% sensitization; aOR 0.07, 0.01–0.25). In longitudinal analyses, these associations were driven by a higher odds of outgrowing early sensitization and a lower odds of late-onset sensitization. There was no apparent benefit (or harm) from maternal peanut consumption without breastfeeding. Taken together, these results suggest the combination of maternal peanut consumption and breastfeeding at the time of peanut introduction during infancy may help to decrease the risk of peanut sensitization. Mechanistic and clinical intervention studies are needed to confirm and understand this “triple exposure” hypothesis.

At present, analysis of diet and bladder cancer (BC) is mostly based on the intake of individual foods. The examination of food combinations provides a scope to deal with the complexity and unpredictability of the diet and aims to overcome the limitations of the study of nutrients and foods in isolation. This article aims to demonstrate the usability of supervised data mining methods to extract the food groups related to BC. In order to derive key food groups associated with BC risk, we applied the data mining technique C5.0 with 10-fold cross-validation in the BLadder cancer Epidemiology and Nutritional Determinants study, including data from eighteen case–control and one nested case–cohort study, compromising 8320 BC cases out of 31 551 participants. Dietary data, on the eleven main food groups of the Eurocode 2 Core classification codebook, and relevant non-diet data (i.e. sex, age and smoking status) were available. Primarily, five key food groups were extracted; in order of importance, beverages (non-milk); grains and grain products; vegetables and vegetable products; fats, oils and their products; meats and meat products were associated with BC risk. Since these food groups are corresponded with previously proposed BC-related dietary factors, data mining seems to be a promising technique in the field of nutritional epidemiology and deserves further examination.

Let $G$ be an anisotropic semisimple group over a totally real number field $F$. Suppose that $G$ is compact at all but one infinite place $v_{0}$. In addition, suppose that $G_{v_{0}}$ is $\mathbb{R}$-almost simple, not split, and has a Cartan involution defined over $F$. If $Y$ is a congruence arithmetic manifold of non-positive curvature associated with $G$, we prove that there exists a sequence of Laplace eigenfunctions on $Y$ whose sup norms grow like a power of the eigenvalue.

By assuming the endoscopic classification of automorphic representations on inner forms of unitary groups, which is currently work in progress by Kaletha, Minguez, Shin, and White, we bound the growth of cohomology in congruence towers of locally symmetric spaces associated to $U(n,1)$. In the case of lattices arising from Hermitian forms, we expect that the growth exponents we obtain are sharp in all degrees.

In this study, we examined the Candrive baseline data (n = 928; aged 70 to 94; 62% were men) to determine whether driver characteristics (i.e., age, gender, height, weight, BMI) and certain functional abilities (i.e., Rapid Paced Walk, Timed Up and Go) influenced the types of vehicles driven. There were significant differences with respect to type of vehicle and mean driver age (F = 3.58, p = 0.003), height, (F = 13.32, p < 0.001), weight (F = 14.31, p < 0.001), and BMI (F = 4.40, p = 0.001). A greater proportion of drivers with osteoporosis (χ2 = 21.23, p = 0.020) and osteo/rheumatoid arthritis (χ2 = 21.23, p = 0.020) drove small and medium-sized cars compared to larger ones. Further research is needed to examine older driver-vehicle interactions, and the relationship to demographics and functional abilities, given the vulnerability of this age group to automotive-related injuries.

Specific antibody responses were assessed in pigs immunized with the Taenia solium vaccine TSOL18. Anti-TSOL18 responses were compared 2 weeks after secondary immunization, where the interval between primary and secondary immunization was 4, 8, 12, 16 or 20 weeks. All animals responded to the vaccine and there was no diminution in antibody responses in animals receiving their second injection after an interval up to 20 weeks. Pigs receiving vaccinations at an interval of 12 weeks developed significantly increased antibody responses compared with animals receiving immunizations 4 weeks apart (P = 0·046). The ability to deliver TSOL18 vaccination effectively where the revaccination schedule can be delayed for up to 12–16 weeks in pigs increases the options available for designing T. solium control interventions that incorporate TSOL18 vaccination.

The whale shark Rhincodon typus is a popular focal species in the marine tourism industry. We analysed 689 encounters with at least 142 individual sharks during 2008–2010 to assess their behaviour in the presence of swimmers at Tofo Beach, Mozambique. Sharks varied in size (estimated 3.0–9.5 m total length) and the majority (74%) were males. The sharks displayed avoidance behaviours during 64.7% of encounters. Encounter duration decreased significantly, from 12 minutes 37 s with undisturbed sharks to 8 minutes 25 s when sharks expressed avoidance behaviours, indicating that interactions with tourists affected the sharks’ short-term behaviour. However, during the 2.5-year study period we found no trend in the mean encounter duration, the overall expression of avoidance behaviour or the likelihood of an individual shark exhibiting avoidance behaviours. Potential effects of tourism may be mitigated by the non-breeding status and transient behaviour of sharks at this aggregation site.

We apply the endoscopic classification of automorphic forms on $U(3)$ to study the growth of the first Betti number of congruence covers of a Picard modular surface. As a consequence, we establish a case of a conjecture of Sarnak and Xue on cohomology growth.

Cationic polycyclic aromatic hydrocarbons (PAHs) are attractive candidates for the Diffuse Interstellar Bands, but to date not a single PAH species has been identified on the basis of a spectral agreement. This indicates either that the molecular diversity is very large or that the candidates that have been considered are not the correct ones. In particular, small/medium-sized PAH cations are submitted to photodissociation under UV photons from stars. Therefore it is of interest to characterize the spectroscopic properties of key breakdown products. Furthermore, these studies should be performed under conditions that mimic those found in interstellar space, which leads to additional experimental difficulties. We describe the approach we are developing with the PIRENEA set-up and present results on the 1-Methylpyrene cation and photo-derived species. Experimental measurements are guided by calculations based on density functional theory.

Examining the relationship between glucose intolerance and dietary intake in genetically similar populations with different dietary patterns and rates of type 2 diabetes may provide important insights into the role of diet in the pathogenesis of this disease. The objective of the present study was to assess the relationship between dietary variables and dysglycaemia/type 2 diabetes among three populations of African origin. The study design consists of a cross-sectional study of men and women of African descent aged 24–74 years from Cameroon (n 1790), Jamaica (n 857) and Manchester, UK (n 258) who were not known to have diabetes. Each participant had anthropometric measurements and underwent a 2 h 75 g oral glucose tolerance test. Habitual dietary intake was estimated with quantitative FFQ, developed specifically for each country. The age-adjusted prevalence of undiagnosed type 2 diabetes in Cameroon was low (1·1 %), but it was higher in Jamaica (11·6 %) and the UK (12·6 %). Adjusted generalised linear and latent mixed models used to obtain OR indicated that each 1·0 % increment in energy from protein, total fat and saturated fats significantly increased the odds of type 2 diabetes by 9 (95 % CI 1·02, 1·16) %, 5 (95 % CI, 1·01, 1·08) % and 16 (95 % CI 1·08, 1·25) %, respectively. A 1 % increase in energy from carbohydrates and a 0·1 unit increment in the PUFA:SFA ratio were associated with significantly reduced odds of type 2 diabetes. The results show independent effects of dietary factors on hyperglycaemia in African origin populations. Whether modifying intake of specific macronutrients helps diabetes prevention needs testing in randomised trials.

Thin transparent conducting oxide (TCO) films of gallium-doped zinc oxide have been deposited on glass substrates by atomic layer deposition (ALD) using diethyl zinc, triethyl gallium and water vapour as precursors. The gallium-doped zinc oxide films were deposited over the temperature range 100-350°C. Transmission electron microscopy reveals that the as-deposited films are polycrystalline in character. The electrical resistivity of the gallium-doped zinc oxide films was evaluated using four-point probe and contactless measurement methods as a function of film thickness. The lowest sheet resistance of 16 Ω/☐ was measured from a film thickness of 400nm and a gallium content of 5 atomic percent. The electron Hall mobility of this film was 12.3 cm2/Vs. The visible transmittance of the films was 78% with a haze of 0.2%.

The proposed mechanism for Reducing Emissions from Deforestation and Degradation (REDD+) offers significant potential for conserving forests to reduce negative impacts of climate change. Tanzania is one of nine pilot countries for the United Nations REDD Programme, receives significant funding from the Norwegian, Finnish and German governments and is a participant in the World Bank’s Forest Carbon Partnership Facility. In combination, these interventions aim to mitigate greenhouse gas emissions, provide an income to rural communities and conserve biodiversity. The establishment of the UN-REDD Programme in Tanzania illustrates real-world challenges in a developing country. These include currently inadequate baseline forestry data sets (needed to calculate reference emission levels), inadequate government capacity and insufficient experience of implementing REDD+-type measures at operational levels. Additionally, for REDD+ to succeed, current users of forest resources must adopt new practices, including the equitable sharing of benefits that accrue from REDD+ implementation. These challenges are being addressed by combined donor support to implement a national forest inventory, remote sensing of forest cover, enhanced capacity for measuring, reporting and verification, and pilot projects to test REDD+ implementation linked to the existing Participatory Forest Management Programme. Our conclusion is that even in a country with considerable donor support, progressive forest policies, laws and regulations, an extensive network of managed forests and increasingly developed locally-based forest management approaches, implementing REDD+ presents many challenges. These are being met by coordinated, genuine partnerships between government, non-government and community-based agencies.

In recognition of the fact that orang-utans (Pongo spp.) are severely threatened, a meeting of orang-utan experts and conservationists, representatives of national and regional governmental and non-governmental organizations, and other stakeholders, was convened in Jakarta, Indonesia, in January 2004. Prior to this meeting we surveyed all large areas for which orang-utan population status was unknown. Compilation of all survey data produced a comprehensive picture of orang-utan distribution on both Borneo and Sumatra. These results indicate that in 2004 there were c. 6,500 P. abelii remaining on Sumatra and at least 54,000 P. pygmaeus on Borneo. Extrapolating to 2008 on the basis of forest loss on both islands suggests the estimate for Borneo could be 10% too high but that for Sumatra is probably still relatively accurate because forest loss in orang-utan habitat has been low during the conflict in Aceh, where most P. abelii occur. When those population sizes are compared to known historical sizes it is clear that the Sumatran orang-utan is in rapid decline, and unless extraordinary efforts are made soon, it could become the first great ape species to go extinct. In contrast, our results indicate there are more and larger populations of Bornean orang-utans than previously known. Although these revised estimates for Borneo are encouraging, forest loss and associated loss of orang-utans are occurring at an alarming rate, and suggest that recent reductions of Bornean orang-utan populations have been far more severe than previously supposed. Nevertheless, although orang-utans on both islands are under threat, we highlight some reasons for cautious optimism for their long-term conservation.