Modulation of Carbon Nanotube Electronic Structure by Grain Boundary Defects in RbI on Au(111).

The electronic properties of single-walled carbon nanotubes (SWCNTs) are known to be highly sensitive to environmental effects. Here, we use scanning tunneling microscopy and spectroscopy to investigate the electronic properties of SWCNTs deposited on RbI monolayer films grown on Au(111). We find that grain boundary defects in RbI monolayers cause the appearance of spatially confined localized states in the SWCNTs. Our density functional theory calculations show that grain boundary defects in RbI/Au(111) produce a stabilizing electrostatic potential caused by reduced coordination of iodine atoms at the RbI grain boundary. The presented results may offer insights into the performance of devices involving transport through SWCNTs subjected to external electrostatic disorder.

Depression and Anxiety Symptoms and Treatment Utilization, and Associated HIV Outcomes among Adults with HIV in Rural Florida.

Persons living with HIV (PLWH) and depression or anxiety in the rural South may have suboptimal HIV outcomes. We sought to examine the proportion of PLWH from rural Florida with symptoms of depression or anxiety, the proportion who received depression or anxiety treatment, and the relationship between untreated and treated symptoms of depression or anxiety and HIV outcomes. Cross-sectional survey data collected between 2014 and 2018 were analyzed. Among 187 PLWH residing in rural Florida (median age 49 years, 61.5%, male 45.5% Black), 127 (67.9%) met criteria for symptoms of depression and/or anxiety. Among these 127 participants, 60 (47.2%) were not on depression or anxiety treatment. Participants with untreated symptoms of depression and anxiety (OR 3.2, 95% CI 1.2-9.2, p = 0.03) and treated depression and anxiety with uncontrolled symptoms (OR 1.4, 95% CI 0.5-4.0, p = 0.52) were more likely to have viral non-suppression compared to those without depression or anxiety in an unadjusted bivariate analysis. Only the association between untreated symptoms of depression and anxiety and viral non-suppression was statistically significant, and when adjusting for social and structural confounders the association was attenuated and was no longer statistically significant. This suggests that social and structural barriers impact both mental health and HIV outcomes. Our findings support the need for increased mental health services and resources that address the social and structural barriers to care for PLWH in the rural South.

Spatially modulated interface states in a two-dimensional potential: Single-layer RbI on Ag(111).

Alkali halides are known to exhibit interface electronic states (IES) when deposited on metal surfaces with ultra-thin coverage. Here, we examine the IES formed by sub-monolayer RbI growth on Ag(111), which exhibits spatial variations in electronic structure in surprising contrast to the results previously obtained for other alkali halides. We find that this spatially dependent behavior can be qualitatively modeled by using a two-dimensional cosine potential commensurate with the moiré superstructure, where the IES is constructed from the well-known analytical solutions to the Mathieu equation. Our results indicate this potential is more corrugated than for similar potentials reported for other alkali halides, a result of substrate-adlayer charge transfer interactions that are stronger for RbI. This two-dimensional effective potential leads to anisotropy in the effective electron mass, in surprising contrast to previous results for other alkali halides, which report a single isotropic mass.

The Black Foe: Being Towards Death.

The ontology of death is universal, hence archetypal. Nowhere do we witness any organic creature escape its talons. Analytical psychology has had an intimate relationship to death for the simple fact that it contemplates the soul, the numinous, and an afterlife. From Hegel to Heidegger, Freud and Jung, death was an existential force that sustained and transformed life, the positive significance of the negative. Rather than merely a destructive phenomenon, death informs Being, the power of nothingness that dialectically drives life. In this paper, I will introduce the notion of what I call the omega principle, the psychological orientation and trajectory of our being towards death, which we may say is a universal preoccupation and recapitulation of the collective unconscious that subsumes our personal relation to death, an eternal return of the objective psyche constellated as esse in anima.

L'ontologie de la mort est universelle, et ainsi archétypale. Nous ne voyons nulle part une créature organique échapper à son emprise. La psychologie analytique a eu une relation intime avec la mort du simple fait qu'elle contemple l'âme, le numineux et l'au-delà. De Hegel à Heidegger, Freud et Jung, la mort était une force existentielle qui soutenait et transformait la vie, la signification positive du négatif. Plutôt qu'un simple phénomène destructeur, la mort façonne l'Etre ; la puissance du néant qui conduit dialectiquement la vie. Dans cet article, je vais présenter l'idée que j'appelle le principe oméga ; l'orientation et la trajectoire psychologiques de notre être allant vers la mort, dont nous pourrions dire qu'il s'agit d'une préoccupation et d'une récapitulation universelle de l'inconscient collectif, qui englobe notre relation personnelle à la mort, un retour éternel de la psyché objective constellée en tant qu'esse in anima.

La ontología de la muerte es universal, por tanto arquetípica. Ninguna criatura orgánica escapa a sus garras. La psicología analítica ha tenido una relación íntima con la muerte por el simple hecho de que contempla el alma, lo numinoso y una vida después de la muerte. De Hegel a Heidegger, Freud y Jung, la muerte era una fuerza existencial que sostenía y transformaba la vida, el significado positivo de lo negativo. Más que un mero fenómeno destructivo, la muerte informa al Ser, el poder de la nada que impulsa dialécticamente la vida. En este artículo, introduciré la noción de lo que denomino principio omega, la orientación y trayectoria psicológica de nuestro ser hacia la muerte, que podemos decir que es una preocupación y recapitulación universal del inconsciente colectivo que subsume nuestra relación personal con la muerte, un eterno retorno de la psique objetiva constelada como esse in anima.

Structural Bistability in RbI Monolayers on Ag(111).

Alkali halides are well-known for their tendency to form rock-salt-like crystal structures. Here we present a scanning tunneling microscopy study of a previously unreported alternative structure of one such alkali halide, RbI. When deposited on Ag(111) at a low submonolayer surface coverage, RbI forms islands with hexagonally coordinated atomic structures, in contrast to the expected rock-salt structures typically observed for such alkali halide films on metal surfaces. At a near-monolayer RbI surface coverage, we observe the coexistence of the hexagonally coordinated phase and a square-coordinated rock-salt-like RbI phase that is analogous to that observed for other alkali halides. Our density functional theory calculations for this system highlight the role of RbI-Ag interfacial charge transfer in defining the RbI structure and the impact of local atomic coordination on the RbI-Ag charge-transfer interaction.

Beyond Viral Suppression-The Impact of Cumulative Violence on Health-Related Quality of Life Among a Cohort of Virally Suppressed Patients.

OBJECTIVE: To elucidate how and in what ways cumulative violence affects health-related quality of life (HRQoL) among a clinical cohort of virally stable people living with HIV. DESIGN: We used data from the University of North Carolina Center for AIDS Research HIV clinical cohort. Our analysis was limited to participants with an undetectable viral load (<200) and those who completed the Clinical, Sociodemographic, and Behavioral Survey between 2008 and 2017 ( n = 284). METHODS: A path analysis was used to test our primary hypothesis that the effect of cumulative violence on HRQoL would be mediated through symptoms of post-traumatic stress disorder (PTSD), depressive symptoms, and HIV symptom distress. RESULTS: The impact of cumulative violence on HRQoL was fully mediated by symptoms of PTSD, depressive symptoms, and HIV symptom distress. Greater exposure to violence was associated with higher odds of PTSD symptoms ( P <0.001), increased depressive symptoms ( P <0.001), and increased HIV symptom distress ( P < 0.01). HIV symptom distress displayed the largest association with HRQoL ( P < 0.001), followed by depressive symptoms ( P = 0.001) and PTSD symptoms ( P < 0.001). These factors explained approximately 51% of the variance in HRQoL ( R2 = 0.51, P < 0.001). CONCLUSIONS: Our findings indicate that addressing physical and mental health symptoms rooted in violent victimization should be a point of focus in efforts to improve HRQoL among people living with HIV who are virally stable.

Towards a digital twin for supporting multi-agency incident management in a smart city.

Cost-effective on-demand computing resources can help to process the increasing number of large, diverse datasets generated from smart internet-enabled technology, such as sensors, CCTV cameras, and mobile devices, with high temporal resolution. Category 1 emergency services (Ambulance, Fire and Rescue, and Police) can benefit from access to (near) real-time traffic- and weather data to coordinate multiple services, such as reassessing a route on the transport network affected by flooding or road incidents. However, there is a tendency not to utilise available smart city data sources, due to the heterogeneous data landscape, lack of real-time information, and communication inefficiencies. Using a systems engineering approach, we identify the current challenges faced by stakeholders involved in incident response and formulate future requirements for an improved system. Based on these initial findings, we develop a use case using Microsoft Azure cloud computing technology for analytical functionalities that can better support stakeholders in their response to an incident. Our prototype allows stakeholders to view available resources, send automatic updates and integrate location-based real-time weather and traffic data. We anticipate our study will provide a foundation for the future design of a data ontology for multi-agency incident response in smart cities of the future.

Service utilization in Medicaid HIV specialty plans versus standard plans among enrollees diagnosed with HIV/AIDS in Florida, U.S.A.

In the United States (U.S.), to contain costs many state Medicaid programs offer specialty health insurance plans for costly conditions such as HIV/AIDS. This study compared service utilization between Florida Medicaid enrollees diagnosed with HIV/AIDS in standard Medicaid managed care plans to enrollees in HIV/AIDS specialty plans. We found lower mean utilization among HIV/AIDS enrollees in specialty plans compared to enrollees with HIV/AIDS in standard MMA plans for all services except inpatient which was approximately the same. While fewer emergency visits is a desired outcome, lower rates of other services may indicate suboptimal management of patients or lower engagement in care among enrollees in HIV/AIDS specialty plans. Continuous monitoring of experiences of patients in HIV/AIDS specialty plans is warranted to determine whether the observed utilization patterns represent better management through reductions in low value care or reduced engagement in care, and whether these utilization patterns persist.

The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment.

BACKGROUND: Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. SETTING: A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US. METHODS: This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL). RESULTS: The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95% confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, -0.01 to 0.03], being <95% ART adherent (RR = 1.27, 1.06-1.52; RD = 0.04, -0.01 to 0.07), and virological failure (RR = 1.09, 1.01-1.18; RD = 0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent. CONCLUSIONS: Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.

The myth of the collective unconscious.

This essay challenges the most basic tenet of Jung's analytical psychology, namely, the existence of the collective unconscious. Despite the fact that there are purported to be universal processes and ontological features of mind throughout all psychoanalytical schools of thought, Jung's is unique in the history of psychoanalytic ideas for positing a supraordinate, autonomous transpersonal psyche that remains the source, ground, and wellspring from which all unconscious and conscious manifestations derive. This bold claim is analyzed through a close inspection of Jung's texts that questions the philosophical justification for postulating a supernatural macroanthropos or reified collective mind. Pointing out the problems of agency and fallacies of hypostatization, it is not necessary to evoke a transpersonal cosmogony to explain how universality suffuses individual subjectivity within social collectives. Here we may conclude that the collective unconscious construct is a signifier for the common psychological dynamics and characteristics of shared humanity. In this sense, the myth of the collective unconscious is better understood as a metaphor for a higher abstraction or ideal principle ordained with numinous value.

Cumulative Burden of Depression and All-Cause Mortality in Women Living With Human Immunodeficiency Virus.

Background: Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary "always vs never" characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings. Methods: Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models. Results: Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34-2.20). Conclusions: In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.

Estimation of vegetation water content at leaf and canopy level using dual-wavelength commercial terrestrial laser scanners.

Vegetation water content, quantified as the leaf equivalent water thickness (EWT), can serve as an indicator of vegetation stress. The intensity data recorded by terrestrial laser scanning (TLS) instruments, operating at shortwave infrared wavelengths, can be used to estimate the three-dimensional distribution of EWT, after a full and rigorous calibration for the range and incidence angle effects. However, TLS instruments do not record the incidence angles automatically, making calibration challenging. In this study, intensity data from two commercially available TLS instruments (Leica P40, 1550 nm shortwave infrared wavelength, and Leica P20, 808 nm near-infrared wavelength) were combined in a normalized difference index (NDI). The NDI was found to minimize the incidence angle effects with no need for further calibration. A dry-down experiment was conducted using deciduous and conifer canopies. The NDI was found to be highly correlated to EWT at leaf level (R2 of 0.91 and 0.74) and at canopy level (R2 of 0.89 and 0.74) for the deciduous and conifer canopies, respectively. Three-dimensional distributions of EWT at canopy level were generated, which revealed some vertical heterogeneity.

Association of Increased Chronicity of Depression With HIV Appointment Attendance, Treatment Failure, and Mortality Among HIV-Infected Adults in the United States.

Importance: Depression commonly affects adults with HIV and complicates the management of HIV. Depression among individuals with HIV tends to be chronic and cyclical, but the association of this chronicity with HIV outcomes (and the related potential for screening and intervention to shorten depressive episodes) has received little attention. Objective: To examine the association between increased chronicity of depression and multiple HIV care continuum indicators (HIV appointment attendance, treatment failure, and mortality). Design, Setting, and Participants: The study comprised an observational clinical cohort of 5927 patients with 2 or more assessments of depressive severity who were receiving HIV primary care at 6 geographically dispersed US academic medical centers from September 22, 2005, to August 6, 2015. Main Outcomes and Measures: Missing a scheduled HIV primary care visit, detectable HIV RNA viral load (≥75 copies/mL), and all-cause mortality. Consecutive depressive severity measures were converted into a time-updated measure: percentage of days with depression (PDD), following established methods for determining depression-free days. Results: During 10 767 person-years of follow-up, the 5927 participants (5000 men, 926 women, and 1 intersex individual; median age, 44 years [range, 35-50 years]) had a median PDD of 14% (interquartile range, 0%-48%). During follow-up, 10 361 of 55 040 scheduled visits (18.8%) were missed, 6191 of 28 455 viral loads (21.8%) were detectable, and the mortality rate was 1.5 deaths per 100 person-years. Percentage of days with depression showed a dose-response relationship with each outcome. Each 25% increase in PDD led to an 8% increase in the risk of missing a scheduled appointment (risk ratio, 1.08; 95% CI, 1.05-1.11), a 5% increase in the risk of a detectable viral load (risk ratio, 1.05; 95% CI, 1.01-1.09), and a 19% increase in the mortality hazard (hazard ratio, 1.19; 95% CI, 1.05-1.36). These estimates imply that, compared with patients who spent no follow-up time with depression (PDD, 0%), those who spent the entire follow-up time with depression (PDD, 100%) faced a 37% increased risk of missing appointments (risk ratio, 1.37; 95% CI, 1.22-1.53), a 23% increased risk of a detectable viral load (risk ratio, 1.23; 95% CI, 1.06-1.43), and a doubled mortality rate (hazard ratio, 2.02; 95% CI, 1.20-3.42). Conclusions and Relevance: Greater chronicity of depression increased the likelihood of failure at multiple points along the HIV care continuum. Even modest increases in the proportion of time spent with depression led to clinically meaningful increases in negative outcomes. Clinic-level trials of protocols to promptly identify and appropriately treat depression among adults living with HIV should be conducted to understand the effect of such protocols on shortening the course and preventing the recurrence of depressive illness and improving clinical outcomes.

Key attributes of patient centered medical homes associated with patient activation of diabetes patients.

BACKGROUND: Approximately 24 million Americans are living with diabetes. Patient activation among individuals with diabetes is critical to successful diabetes management. The Patient Centered Medical Home (PCMH) model holds promise for increasing patient activation in managing their health. However, what is not well understood is the extent to which individual components of the PCMH model, such as the quality of physician-patient interactions and organizational features of care, contribute to patient activation. This study's objective is to determine the relative importance of the PCMH constructs or domains to patient activation among individuals living with diabetes. METHODS: This study is a cross-sectional analysis of 1253 primary care patients surveyed with type II diabetes. The dependent variable, patient activation, was assessed using the Patient Activation Measure (PAM). Independent variables included 7 PCMH domains- organizational access, integration of care, comprehensive knowledge, office staff helpfulness, communication, interpersonal treatment and trust. Ordered logistic regression was performed to determine whether each PCMH domain was independently associated with patient activation, followed by a final ordered logistic regression that included all the PCMH domains in a single adjusted model. RESULTS: Using the full adjusted model, the odds of patients reporting higher activation scores (PAM) were found to be significant in the domains that represented organizational access (OR 1.56, 95% CI 1.31-1.85) and comprehensive knowledge (OR 1.44, 95% CI 1.13-1.85). CONCLUSIONS: Many practices have struggled with the challenge to develop fully functional patient-centered medical homes. In an effort to become more patient-centered, this study aimed to address what factors activated diabetic patients to adhere to diabetes management plan. Understanding these factors can help identify PCMH attributes that practices can prioritize and improve upon to assist their patients in improving health outcomes. TRIAL REGISTRATION: Study was not a clinical trial; therefore it was not registered.

Creation and Annihilation of Charge Traps in Silicon Nanocrystals: Experimental Visualization and Spectroscopy.

Recent studies have shown the presence of an amorphous surface layer in nominally crystalline silicon nanocrystals (SiNCs) produced by some of the most common synthetic techniques. The amorphous surface layer can serve as a source of deep charge traps, which can dramatically affect the electronic and photophysical properties of SiNCs. We present results of a scanning tunneling microscopy/scanning tunneling spectroscopy (STM/STS) study of individual intragap states observed on the surfaces of hydrogen-passivated SiNCs deposited on the Au(111) surface. STS measurements show that intragap states can be formed reversibly when appropriate voltage-current pulses are applied to individual SiNCs. Analysis of STS spectra suggests that the observed intragap states are formed via self-trapping of charge carriers injected into SiNCs from the STM tip. Our results provide a direct visualization of the charge trap formation in individual SiNCs, a level of detail which until now had been achieved only in theoretical studies.

Comparative effectiveness of dual vs. single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression.

OBJECTIVE: Depression is highly prevalent among people living with HIV/AIDS (PLWHA) and has deleterious effects on HIV clinical outcomes. We examined changes in depression symptoms, viral suppression, and CD4 T cells/µl among PLWHA diagnosed with depression who initiated antidepressant treatment during routine care, and compared the effectiveness of dual-action and single-action antidepressants for improving those outcomes. DESIGN: Comparative effectiveness study of new user dual-action or single-action antidepressant treatment episodes occurring from 2004 to 2014 obtained from the Center for AIDS Research Network of Integrated Clinical Systems. METHODS: We identified new user treatment episodes with no antidepressant use in the preceding 90 days. We completed intent-to-treat and per protocol evaluations for the main analysis. Primary outcomes, were viral suppression (HIV viral load <200 copies/ml) and CD4 T cells/µl. In a secondary analysis, we used the Patient Health Questionnaire-9 (PHQ-9) to evaluate changes in depression symptoms and remission (PHQ <5). Generalized estimating equations with inverse probability of treatment weights were fitted to estimate treatment effects. RESULTS: In weighted intent-to-treat analyses, the probability of viral suppression increased 16% after initiating antidepressants [95% confidence interval = (1.12, 1.20)]. We observed an increase of 39 CD4T cells/µl after initiating antidepressants (30, 48). Both the frequency of remission from depression and PHQ-9 scores improved after antidepressant initiation. Comparative effectiveness estimates were null in all models. CONCLUSION: Initiating antidepressant treatment was associated with improvements in depression, viral suppression, and CD4 T cells/µl, highlighting the health benefits of treating depression in PLWHA. Dual and single-action antidepressants had comparable effectiveness.

Comparative effectiveness of dual-action versus single-action antidepressants for the treatment of depression in people living with HIV/AIDS.

BACKGROUND: Depression is the most common psychiatric comorbidity among people living with HIV/AIDS (PLWHA). Little is known about the comparative effectiveness between different types of antidepressants used to treat depression in this population. We compared the effectiveness of dual-action and single-action antidepressants in PLWHA for achieving remission from depression. METHODS: We used data from the Centers for AIDS Research Network of Integrated Clinic Systems to identify 1175 new user dual-action or single-action antidepressant treatment episodes occurring from 2005 to 2014 for PLWHA diagnosed with depression. The primary outcome was remission from depression defined as a Patient Health Questionnaire-9 (PHQ-9) score <5. Mean difference in PHQ-9 depressive symptom severity was a secondary outcome. The main approach was an intent-to-treat (ITT) evaluation complemented with a per protocol (PP) sensitivity analysis. Generalized linear models were fitted to estimate treatment effects. RESULTS: In ITT analysis, 32% of the episodes ended in remission for both dual-action and single-action antidepressants. The odds ratio (OR) of remission was 1.02 (95%CI=0.63,1.67). In PP analysis, 40% of dual-action episodes ended in remission compared to 32% in single-action episodes. Dual-action episodes had 1.33 times the odds of remission (95%CI=0.55,3.21), however the result was not statistically significant. Non-significant differences were also observed for depressive symptom severity. LIMITATIONS: Missing data was common but was addressed with inverse probability weights. CONCLUSIONS: Results suggest that single-action and dual-action antidepressants are equally effective in PLWHA. Remission was uncommon highlighting the need to identify health service delivery strategies that aid HIV providers in achieving full remission of their patients' depression.

Quantum Confinement of Surface Electrons by Molecular Nanohoop Corrals.

Quantum confinement of two-dimensional surface electronic states has been explored as a way for controllably modifying the electronic structures of a variety of coinage metal surfaces. In this Letter, we use scanning tunneling microscopy and spectroscopy (STM/STS) to study the electron confinement within individual ring-shaped cycloparaphenylene (CPP) molecules forming self-assembled films on Ag(111) and Au(111) surfaces. STM imaging and STS mapping show the presence of electronic states localized in the interiors of CPP rings, inconsistent with the expected localization of molecular electronic orbitals. Electronic energies of these states show considerable variations correlated with the molecular shape. These observations are explained by the presence of localized states formed due to confinement of surface electrons by the CPP skeletal framework, which thus acts as a molecular electronic "corral". Our experiments suggest an approach to robust large-area modification of the surface electronic structure via quantum confinement within molecules forming self-assembled layers.