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Throughout the Phanerozoic, estimated CO2 levels from CO2 proxies generally correlate well with independent estimates of temperature. However, some proxy estimates of atmospheric CO2 during the Late Cretaceous and early Paleocene are low (<400 ppm), seemingly at odds with elevated sea surface temperature. Here we evaluate early Paleocene CO2 by applying a leaf gas‐exchange model to Platanites leaves of four early Paleocene localities from the San Juan Basin, New Mexico (65.66–64.59 Ma). We first calibrate the model on two modern Platanus species, Platanus occidentalis and P. × acerifolia, where we find the leaf gas‐exchange model accurately predicts present‐day CO2, with a mean error rate between 5% and 14%. Applying the model to the early Paleocene, we find CO2 varies between ∼660 and 1,140 ppm. These estimates are consistent with more recent CO2 estimates from boron, leaf gas‐exchange, liverwort, and paleosol proxies that all suggest moderate to elevated levels of CO2 during the Late Cretaceous and early Paleocene. These levels of atmospheric CO2 are more in keeping with the elevated temperature during this period. Plain Language Summary: Throughout Earth history, temperature and atmospheric CO2 usually track each other. During the Late Cretaceous to early Paleocene (∼70–60 Ma), global mean surface temperature was ∼8–12.5°C higher than today. However, CO2 estimates are variable, with some estimates equal to or less than present‐day CO2 (∼415 ppm) and at odds with the estimated global temperatures. Here we use a proxy based on leaf gas‐exchange principles (i.e., photosynthesis) to estimate early Paleocene CO2 from fossil Platanites leaves (family Platanaceae) of four early Paleocene localities from the San Juan Basin, New Mexico (65.66–64.59 Ma). We first test and calibrate the proxy on two modern Platanus species, Platanus occidentalis and P. × acerifolia. We find the leaf gas‐exchange model accurately predicts present‐day CO2. Applying the leaf gas‐exchange model to the early Paleocene, we find CO2 varies between ∼660 and 1,140 ppm. Our results are consistent with other proxies, such as boron, paleosol, leaf gas‐exchange, and liverwort proxies, that all suggest moderate to elevated levels of CO2 during the Late Cretaceous and early Paleocene. These levels of atmospheric CO2 are more in line with elevated temperature during this period, consistent with most observations of CO2 and temperature throughout the Phanerozoic. Key Points: Some CO2 proxy estimates from the Late Cretaceous‐early Paleocene are low (<400 ppm), seemingly at odds with elevated sea surface temperatureWe apply a leaf gas‐exchange model to Platanites leaves of four early Paleocene localities from the San Juan Basin, New MexicoOur CO2 estimates, between ∼660 and 1,140 ppm, are congruent with more recent estimates from several other proxy methods [ABSTRACT FROM AUTHOR]

Premise: Reconstructing the light environment and architecture of the plant canopy from the fossil record requires the use of proxies, such as those derived from cell wall undulation, cell size, and carbon isotopes. All approaches assume that plant taxa will respond predictably to changes in light environments. However, most species‐level studies looking at cell wall undulation only consider "sun" or "shade" leaves; therefore, we need a fully quantitative taxon‐specific method. Methods: We quantified the response of cell wall undulation, cell size, and carbon isotopes of Platanus occidentalis using two experimental setups: (1) two growth chambers at low and high light and (2) a series of outdoor growth experiments using green and black shade cloth at different densities. We then developed and applied a proxy for daily light integral (DLI) to fossil Platanites leaves from two early Paleocene floras from the San Juan Basin in New Mexico. Results: All traits responded to light environment. Cell wall undulation was the most useful trait for reconstructing DLI in the geological record. Median reconstructed DLI from early Paleocene leaves was ~44 mol m−2 d−1, with values from 28 to 54 mol m−2 d−1. Conclusions: Cell wall undulation of P. occidentalis is a robust, quantifiable measurement of light environment that can be used to reconstruct the paleo‐light environment from fossil leaves. The distribution of high DLI values from fossil leaves may provide information on canopy architecture; indicating that either (1) most of the canopy mass is within the upper portion of the crown or (2) leaves exposed to more sunlight are preferentially preserved. [ABSTRACT FROM AUTHOR]

Although rare, subclinical tuberculosis disease can be missed during evaluations for latent tuberculosis infection, and can manifest with symptoms during latent tuberculosis treatment. Among over 8000 patients treated for latent tuberculosis we found no evidence of acquired drug resistance, underscoring the safety of rifampin monotherapy for latent tuberculosis. [ABSTRACT FROM AUTHOR]

Earliest Paleocene megafloras from North America are hypothesized to be low diversity and dominated by long-lived cosmopolitan species following the Cretaceous/Paleogene (K/Pg) mass extinction. However, megafloras used to develop this hypothesis are from the Northern Great Plains (NGP) of North America, and relatively little is known about floras from southern basins. Here, we present a quantitative analysis of an earliest Paleocene megaflora (<350 kyr after K/Pg boundary) from the Ojo Alamo Sandstone in the San Juan Basin (SJB), New Mexico. The megaflora, comprising 53 morphotypes, was dominated by angiosperms, with accessory taxa composed of pteridophytes, lycophytes, and conifers. Diversity analyses indicate a species-rich, highly uneven, and laterally heterogeneous flora. Paleoclimate estimates using multivariate and univariate methods indicate warm temperatures and relatively high precipitation consistent with a modern tropical seasonal forest. When compared with contemporaneous floras from the Denver Basin (DB) of Colorado and the Williston Basin (WB) of North Dakota, the SJB flora had significantly higher species richness but lower evenness. Paleoclimate estimates from the SJB were 7–14°C warmer than the estimates for the DB and WB, indicating a shift from a temperate forest in the NGP to a tropical forest in the SJB. These results demonstrate the presence of a latitudinal floral diversity and paleoclimatic gradient during the earliest Paleocene in western North America. We hypothesize that the warm, wet conditions in the earliest Paleocene SJB drove rapid rates of speciation following the K/Pg boundary, resulting in a diverse and heterogeneous flora. [ABSTRACT FROM AUTHOR]

Lifelong ART is essential to reducing HIV mortality and ending the epidemic, however the interplay between socioeconomic position and long-term outcomes of HIV-infected persons receiving antiretroviral therapy (ART) in sub-Saharan Africa is unknown. Furthering the understanding of factors related to long-term ART outcomes in this important region will aid the successful scale-up of ART programs. We enrolled 559 HIV-infected Ugandan adults starting ART in 2004–2005 at the Infectious Diseases Institute in Kampala, Uganda and followed them for 10 years. We documented baseline employment status, regular household income, education level, housing description, physical ability, and CD4 count. Viral load was measured every six months. Proportional hazard regression tested for associations between baseline characteristics and 1) mortality, 2) virologic failure, and 3) mortality or virologic failure as a composite outcome. Over ten years 23% (n = 127) of participants died, 6% (n = 31) were lost-to-follow-up and 23% (107/472) experienced virologic treatment failure. In Kaplan-Meier analysis we observed an association between employment and mortality, with the highest cumulative probability of death occurring in unemployed individuals. In univariate analysis unemployment and disease severity were associated with mortality, but in multivariable analysis the only association with mortality was disease severity. We observed an association between higher household income and an increased incidence of both virologic failure and the combined outcome, and an association between self-employment and lower incidence of virologic failure and the combined outcome when compared to unemployment. Formal education level and housing status were unrelated to outcomes. It is feasible to achieve good ten-year survival, retention-in-care, and viral suppression in a socioeconomically diverse population in a resource-limited setting. Unemployment appears to be related to adverse 10-year ART outcomes. A low level of formal education does not appear to be a barrier to successful long-term ART. [ABSTRACT FROM AUTHOR]

Background. Because of investments in human immunodeficiency virus (HIV) care in sub-Saharan Africa, the number of people aware of their status and receiving antiretroviral therapy (ART) has increased; however, HIV/acquired immune deficiency syndrome (AIDS) mortality still remains high. Methods. We performed retrospective analysis of 3 sequential prospective cohorts of HIV-infected Ugandan adults presenting with AIDS and meningitis from 2006 to 2009, 2010 to 2012, and 2013 to 2016. Participants were categorized as follows: (1) unknown HIV status; (2) known HIV+ without ART; (3) known HIV+ with previous ART. We further categorized 2006 and 2013 cohort participants by duration of HIV-status knowledge and of ART receipt. Results. We screened 1353 persons with suspected meningitis. Cryptococcus was the most common pathogen (63%). Over the decade, we observed an absolute increase of 37% in HIV status knowledge and 59% in antecedent ART receipt at screening. The 2006 cohort participants were new/recent HIV diagnoses (65%) or known HIV+ but not receiving ART (35%). Many 2013 cohort participants were new/recent HIV diagnoses (34%) and known HIV+ with <1 month ART (20%), but a significant proportion were receiving ART 1-4 months (11%) and >4 months (30%). Four percent of participants discontinued ART. From 2010 to 2016, meningitis cases per month increased by 33%. Conclusions. Although improved HIV screening and ART access remain much-needed interventions in resource-limited settings, greater investment in viral suppression and opportunistic infection care among the growing HIV-infected population receiving ART is essential to reducing ongoing AIDS mortality. [ABSTRACT FROM AUTHOR]

Abstract: Paleoecological studies document the net effects of atmospheric and climate change in a natural laboratory over timescales not accessible to laboratory or ecological studies. Insect feeding damage is visible on well‐preserved fossil leaves, and changes in leaf damage through time can be compared to environmental changes. We measured percent leaf area damaged on four fossil leaf assemblages from the Bighorn Basin, Wyoming, that range in age from 56.1 to 52.65 million years (Ma). We also include similar published data from three US sites 49.4 to ~45 Ma in our analyses. Regional climate was subtropical or warmer throughout this period, and the second oldest assemblage (56 Ma) was deposited during the Paleocene–Eocene Thermal Maximum (PETM), a geologically abrupt global warming event caused by massive release of carbon into the atmosphere. Total and leaf‐chewing damage are highest during the PETM, whether considering percent area damaged on the bulk flora, the average of individual host plants, or a single plant host that occurs at multiple sites. Another fossil assemblage in our study, the 52.65 Ma Fifteenmile Creek paleoflora, also lived during a period of globally high temperature and pCO2, but does not have elevated herbivory. Comparison of these two sites, as well as regression analyses conducted on the entire dataset, demonstrates that, over long timescales, temperature and pCO2 are uncorrelated with total insect consumption at the ecosystem level. Rather, the most important factor affecting herbivory is the relative abundance of plants with nitrogen‐fixing symbionts. Legumes dominate the PETM site; their prevalence would have decreased nitrogen limitation across the ecosystem, buffering generalist herbivore populations against decreased leaf nutritional quality that commonly occurs at high pCO2. We hypothesize that nitrogen concentration regulates the opposing effects of elevated temperature and CO2 on insect abundance and thereby total insect consumption, which has important implications for agricultural practices in today's world of steadily increasing pCO2. [ABSTRACT FROM AUTHOR]

Background Seizures commonly occur in patients with cryptococcal meningitis, yet risk factors and outcomes related to seizures are not well described. Methods We performed post hoc analyses on participants prospectively enrolled in 3 separate human immunodeficiency virus (HIV)-associated cryptococcal meningitis clinical trials during 2010–2017. Documentation of seizures at presentation or during hospitalization and antiseizure medication receipt identified participants with seizures. We summarized participant characteristics by seizure status via Kruskal-Wallis and χ 2 tests. Cox proportional hazards models analyzed the relationship between seizures and mortality. We compared mean quantitative neurocognitive performance Z (QNPZ-8) scores, and individual domain z-scores, at 3-months using independent t tests. Results Among 821 HIV-infected cryptococcal meningitis participants, 28% (231 of 821) experienced seizures: 15.5% (127 of 821) experienced seizures at presentation, and 12.7% (104 of 821) experienced incident seizures. Participants with seizures at presentation had a significantly lower Glasgow coma scale ([GCS] <15; P <.001), CD4 count (<50 cells/mcL; P =.02), and higher cerebrospinal fluid (CSF) opening pressure (>25 cm H2O; P =.004) when compared with participants who never experienced seizures. Cerebrospinal fluid fungal burden was higher among those with seizures at presentation (125 000 Cryptococcus colony-forming units [CFU]/mL CSF) and with seizures during follow-up (92 000 CFU/mL) compared with those who never experienced seizures (36 000 CFU/mL, P <.001). Seizures were associated with increased 10-week mortality (adjusted hazard ratio = 1.45; 95% confidence interval, 1.11–1.89). Participants with seizures had lower neurocognitive function at 3 months (QNPZ-8 = −1.87) compared with those without seizures (QNPZ-8 = −1.36; P <.001). Conclusions Seizures were common in this HIV-associated cryptococcal meningitis cohort and were associated with decreased survival and neurocognitive function. [ABSTRACT FROM AUTHOR]

Climate and environment strongly influence the size, shape, and toothiness (physiognomy) of plants' leaves. These relationships, particularly in woody non-monocotyledonous angiosperms, have been used to develop leaf-based proxies for paleoclimate and paleoecology that have been applied to reconstruct ancient terrestrial ecosystems for the last ~120 million years of Earth's history. Additionally, given that these relationships have been documented in living plants, they are important for understanding aspects of plant evolution and how plants respond to climatic and environmental changes. To conduct these types of analyses on modern and fossil plants, leaf physiognomy must be measured accurately using a reproducible methodology. This protocol describes a computer-based method for measuring and analyzing a variety of leaf physiognomic variables in modern and fossil leaves. This method allows for the measurement of leaf physiognomic traits, in particular variables related to leaf serrations, leaf area, leaf dissection, and linearity that are used in the digital leaf physiognomy proxy for reconstructing paleoclimate, as well as petiole width and leaf area, which are used for reconstructing leaf mass per area, a paleoecological proxy. Because this digital leaf trait measurement method can be applied to fossil and living plants, it is not limited to applications related to reconstructing paleoclimate and paleoecology. It can also be used to explore leaf traits that may be informative for understanding the function of leaf morphology, leaf development, phylogenetic relationships of leaf traits, and plant evolution.

Paleoecological studies document the net effects of atmospheric and climate change in a natural laboratory over timescales not accessible to laboratory or ecological studies. Insect feeding damage is visible on well-preserved fossil leaves, and changes in leaf damage through time can be compared to environmental changes. We measured percent leaf area damaged on four fossil leaf assemblages from the Bighorn Basin, Wyoming, that range in age from 56.1 to 52.65 million years (Ma). We also include similar published data from three US sites 49.4 to ~45 Ma in our analyses. Regional climate was subtropical or warmer throughout this period, and the second oldest assemblage (56 Ma) was deposited during the Paleocene-Eocene Thermal Maximum (PETM), a geologically abrupt global warming event caused by massive release of carbon into the atmosphere. Total and leaf-chewing damage are highest during the PETM, whether considering percent area damaged on the bulk flora, the average of individual host plants, or a single plant host that occurs at multiple sites. Another fossil assemblage in our study, the 52.65 Ma Fifteenmile Creek paleoflora, also lived during a period of globally high temperature and pCO 2, but does not have elevated herbivory. Comparison of these two sites, as well as regression analyses conducted on the entire dataset, demonstrates that, over long timescales, temperature and pCO 2 are uncorrelated with total insect consumption at the ecosystem level. Rather, the most important factor affecting herbivory is the relative abundance of plants with nitrogen-fixing symbionts. Legumes dominate the PETM site; their prevalence would have decreased nitrogen limitation across the ecosystem, buffering generalist herbivore populations against decreased leaf nutritional quality that commonly occurs at high pCO 2. We hypothesize that nitrogen concentration regulates the opposing effects of elevated temperature and CO 2 on insect abundance and thereby total insect consumption, which has important implications for agricultural practices in today's world of steadily increasing pCO 2.

Purpose of Review: This article summarizes research and commentaries on psychotherapy for adults with intellectual disabilities published since 2008., Recent Findings: There have been very few empirical studies of the effectiveness of psychotherapy in this context over recent years despite a strong perception that such approaches are not only necessary but also of great value. There have been some interesting, though so far only suggestive, findings concerning the relationship between intellectual level and suitability for treatment, primarily with cognitive behavioural therapy. Therapies based on mindfulness are emerging as important new developments. Despite their heritage, psychodynamic approaches continue to rely on opinion over evidence to support their use., Summary: Research on both processes in therapy and its outcomes needs to be undertaken with renewed vigour if specialist psychotherapy for people with intellectual disability is to flourish, or indeed survive, in the public healthcare system. However, it may have much a broader value for people with intellectual disability, especially those in residential services, than can be easily quantified.