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Paper inthebook/festschrift 'Roman Frontier Archaeology – in Britain and beyond' in honour of Paul Bidwell presented on the occasion of the 30th annual conference of the Arbeia Society, Archaeopress Roman Archaeology 92. Edited by Nick Hodgson and Bill Griffiths.DOI10.32028/9781803273440. Open Accesshttps://www.archaeopress.com/Archaeopress/Products/9781803273440 Abstract of paper: Relative Sea-Level (RSL) change since the mid-1st century AD places limits on the locations of Roman ports on the River Exe. Supplies from Northern Gaul, destined for the Neronian legionary fortress at Exeter and its dependent civilian sites, may be demonstrated to have been unloaded downriver from the fortress at Exeter. Utilising a combination of available historical and archaeological data, glacial isostatic adjustment and estimated RSL over the past 2000 years, confirms that Roman sea-transports or river barges could not have reached the Exeter fortress on the tide. Furthermore, on the basis of the estimated tidal reach and depth of the River Exe in the mid-1st century AD, limitations may be placed on the location of both sea-port and barge-quay facilities, thus allowing the areas of search for these installations to be narrowed.

Relative Sea-Level (RSL) change since the mid-1st century AD places limits on the locations of Roman ports on the River Exe. Supplies from Northern Gaul, destined for the Neronian legionary fortress at Exeter and its dependent civilian sites, may be demonstrated to have been unloaded downriver from the fortress at Exeter. Utilising a combination of available historical and archaeological data, glacial isostatic adjustment and estimated RSL over the past 2000 years, confirms that Roman sea-transports or river barges could not have reached the Exeter fortress on the tide. Furthermore, on the basis of the estimated tidal reach and depth of the River Exe in the mid-1st century AD, limitations may be placed on the location of both sea-port and barge-quay facilities, thus allowing the areas of search for these installations to be narrowed.

These briefs present evidence that states should be targeting participants in Medicaid Home and Community-Based Services (HCBS) programs as high priority vaccine recipients.

MFP was first authorized through the Deficit Reduction Act of 2005 with strong bipartisan support. The program was extended in the Affordable Care Act through September 2016, with flexibility to use funding through 2018. Since then, there have been five short-term extensions to keep the program afloat., However, funding lapses, coupled with short-term extensions to MFP funding, have resulted in a dramatic drop in state efforts to transition people out of institutions.

Summary Background: Antiretroviral therapy (ART) cannot cure HIV infection because of a persistent reservoir of latently infected cells. Approaches that force HIV transcription from these cells, making them susceptible to killing - termed ���kick and kill��� - have been explored as a strategy towards an HIV cure. RIVER is the first randomized trial to determine the impact of ART alone versus ART plus ���kick-and-kill��� on markers of the HIV reservoir. Methods: RIVER (Trial registration: NCT02336074) was an open-label, multicenter, 1:1 randomized controlled trial of ART-only (control) versus ART plus the histone deacetylase inhibitor vorinostat (the ���kick���) and replication-deficient viral vector vaccines encoding conserved HIV sequences ChAdV63.HIVconsv-prime, MVA.HIVconsv-boost T-cell vaccination (the ���kill���) (ART+V+V; intervention) in HIV-positive adults treated in recent HIV-infection. The primary endpoint was total HIV DNA in peripheral blood CD4+ T-cells at weeks 16 and 18 post-randomization. Secondary endpoints included safety, alternative measures of the HIV reservoir including quantitative viral outgrowth, HIV-specific T-cell frequencies, and CD8+ T-cell mediated viral inhibition. Findings: Between December 2015 and November 2017, 60 HIV-positive male participants were randomized (computer-based and stratified by time since diagnosis; 30 participants in each trial arm) and completed the study interventions, with no loss-to-follow-up. There were no intervention-related serious adverse events. Mean total HIV DNA at weeks 16 and 18 was 3.02 log10 copies HIV DNA/106 CD4+ T-cells in the control and 3.06 log10 copies HIV DNA/106 CD4+ T-cells in the intervention arm, with no statistically significant difference (mean difference of 0.04 (95%CI -0.03, 0.11) log10 total HIV DNA copies/106 CD4+ T-cells (p=0.26)). Interpretation: This ���kick-and-kill��� approach conferred no significant benefit compared to ART alone on measures of the HIV reservoir. Although this does not disprove the ���kick and kill��� strategy, for future trials significant enhancement of both ���kick��� and ���kill��� agents will be required., Medical Research Council (MR/L00528X/1).

Human immunodeficiency virus type 1 (HIV-1) infection is associated with aberrant immune activation; however, most model systems for HIV-1 have been used during established infection. Here, we utilize ultrasensitive HIV-1 quantification to delineate early events during the eclipse, burst, and chronic phases of HIV-1 infection in humanized mice. We show that very early in infection, HIV-1 suppresses peripheral type I interferon (IFN) and interferon-stimulated gene (ISG) responses, including the HIV-1 restriction factor IFI44. At the peak of innate immune activation, prior to CD4 T cell loss, HIV-1 infection differentially affects peripheral and lymphoid Toll-like receptor (TLR) expression profiles in T cells and macrophages. This results in a trend toward an altered activation of nuclear factor κB (NF-κB), TANK-binding kinase 1 (TBK1), and interferon regulatory factor 3 (IRF3). The subsequent type I and III IFN responses result in preferential induction of peripheral ISG responses. Following this initial innate immune activation, peripheral expression of the HIV-1 restriction factor SAM domain- and HD domain-containing protein 1 (SAMHD1) returns to levels below those observed in uninfected mice, suggesting that HIV-1 interferes with their basal expression. However, peripheral cells still retain their responsiveness to exogenous type I IFN, whereas splenic cells show a reduction in select ISGs in response to IFN. This demonstrates the highly dynamic nature of very early HIV-1 infection and suggests that blocks to the induction of HIV-1 restriction factors contribute to the establishment of viral persistence.

Since 2007, states with Money Follows the Person (MFP) programs transitioned more than 90,000 people receiving long-term services and supports in institutions back to their homes and communities. Based on institutional population data from multiple sources and on LTSS expenditure data, analyzed separately for people with and without intellectual and other developmental disabilities, this report offers evidence that states with robust MFP programs fared better than states without MFP or with minimal MFP programs, both in terms of reducing institutional populations and expenditures and in rebalancing their LTSS systems. MFP is an important tool for states to use in reducing reliance on institutional services and shifting to home and community-based services.

This study explores the effect of the Affordable Care Act (ACA) on disparities in access to health care based on disability status, as well as age, income, race, and ethnicity. This study found that while the ACA improved overall access to health care and reduced some disparities, substantial disparities persist. Disability status remains associated with much greater risk of delayed or forgone care, and mental health disability is associated with greater likelihood of uninsurance.

The epidemic of acute HCV infection among HIV-infected men who have sex with men (MSM) is ongoing. Transmission of drug-resistant variants (DRVs) after HCV treatment failure could pose a major threat to the effectiveness of future therapies. We determined the baseline prevalence of pre-existing DRVs in the HCV NS3 protease gene and their effects on the addition of telaprevir (TVR) to standard pegylated interferon and ribavirin (PEG-IFN/RBV) for acute HCV infection in individuals enrolled in a multicentre randomized controlled trial (2013 and 2014). The HCV NS3 viral protease was analyzed using Sanger and next-generation sequencing (NGS) for DRVs at baseline (n = 31), and at viral breakthrough following TVR-based treatment (n = 3) or PEG-IFN/RBV alone (n = 2). Sequence analysis indicated that all individuals were infected with HCV genotype 1a. Complete (100%) concordance was seen between Sanger and NGS for high levels of mutant viral populations. The simeprevir-associated Q80K variant was present at high frequency in the German samples (7/11–64%) and infrequently in the UK samples (1/20–5%). In the three TVR-based treatment failures, V36M/l and R155K/T emerged, but not R155G which was detectable at low levels in two individuals at baseline. Failure rate at week 24 was 26.7% (with baseline DRVs) vs. 6.3% (without baseline DRVs), p = 0.17). Comparison of sequences pre- and post-therapy in 5 who failed therapy revealed the emergence of not previously described variants V193G, E176K, P189S (on TVR), and V181S in one instance each. The presence of baseline DRVs for the NS3 protease gene of HCV genotype 1a did not appear to predict treatment failure in our patient cohort. Where detected, Q80K was present at high levels (>98%), but had no effect on outcomes and remained high after failure.

In January 2018, the Centers for Medicare and Medicaid Services (CMS) issued guidance that would allow states to use 1115 Waivers to add “work and community engagement” requirements for working-age Medicaid beneficiaries. This report examines the extent to which disability affects working-age Medicaid beneficiaries, and identifies the subset of beneficiaries with disabilities and work-limiting health conditions who would likely be exempt from proposed Medicaid work requirements or would benefit from modified requirements.

Objectives No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART) at CD4 counts > 350 cells/μL. It is hypothesized that earlier initiation of cART in asymptomatic and otherwise healthy individuals may lead to poorer adherence and subsequently higher rates of resistance development. Methods In a large cohort of HIV-positive individuals, we investigated the emergence of new resistance mutations upon virological treatment failure according to the CD4 count at the initiation of cART. Results Of 7918 included individuals, 6514 (82.3%), 996 (12.6%) and 408 (5.2%) started cART with a CD4 count ≤ 350, 351–499 and ≥ 500 cells/μL, respectively. Virological rebound occurred while on cART in 488 (7.5%), 46 (4.6%) and 30 (7.4%) with a baseline CD4 count ≤ 350, 351–499 and ≥ 500 cells/μL, respectively. Only four (13.0%) individuals with a baseline CD4 count > 350 cells/μL in receipt of a resistance test at viral load rebound were found to have developed new resistance mutations. This compared to 107 (41.2%) of those with virological failure who had initiated cART with a CD4 count

An essay based on spreadsheet calculations for campaigning Roman armies. The spreadsheet is available at www.bandaarcgeophysics.co.uk/arch_intro.html . It allows the definition of army sizes, march rates and the building of camp defences before calculating over 70 parameters and metrics. Calculated camps sizes are cross-matched to extant camps allowing comparisons.This essay contains a description of the spreadsheet, some observations arising and a description of all input and output variables.

The Better Care Reconciliation Act (BCRA) proposes to cap Federal Medicaid reimbursements to the states on a per-enrollee basis, effectively limiting growth to a rate at first only modestly exceeding the rate of inflation in healthcare costs and then falling below inflation. If the BCRA were to be enacted, it is reasonable to assume that most states would limit home and community-based services (HCBS) spending to the per-enrollee cap amount; otherwise, any excess comes entirely out of the state budget.

This evaluation was funded by The SCAN Foundation—advancing a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. For more information, visit www.TheSCANFoundation.org.

We show that intensification of treatment with maraviroc in patients chronically infected with HIV-1 receiving successful long-term ART was not associated with improvements in HIV related morbidity, HIV reservoir, microbial translocation, immune activation or immune exhaustion in either gut or peripheral blood. The measurement of reservoir in both gut and blood longitudinally contributes to a paucity of data in the area.

This report is part of an evaluation of Cal MediConnect, California's demonstration project to integrate care for people covered under both Medicare and Medicaid. The evaluation is being conducted by the Community Living Policy Center at UCSF and the Health Research for Action Center at UC Berkeley, and is funded by The SCAN Foundation and NIDILRR. This report presents findings from a survey of Cal MediConnect beneficiaries and comparison samples conducted over the telephone in early 2016. With respect to long-term services and supports, LTSS-using beneficiaries in Cal MediConnect report that health plans typically do not ask them about their LTSS, and that rarely was the beneficiary aware of any change that had been made to their LTSS as a result.

Surveys of consumers or their families and caregivers are an essential means of assessing quality in the delivery of home and community-based services (HCBS). A substantial number of such surveys have been fielded for the purpose either of measuring HCBS quality generally or of specific aspects of HCBS quality. Other surveys not developed for HCBS nevertheless measure concepts that are important in HCBS quality, such as life satisfaction or community participation. As the need for implementation of quality metrics in HCBS becomes ever more urgent, it is important to understand which quality-related concepts have been addressed in some form by existing surveys, and how well, and which concepts are generally lacking in relevant survey content.