Men and Sex : Construction of male sexuality and the implications for HIV prevention in urban settings in Kenya and South Africa

Background: The perspectives of heterosexual males who engage in high risk sexual behaviours with large sexual networks and concurrent partners are scarcely documented, but these are crucial in the understanding of the high HIV prevalence. Little is known about the sexual life and sexual risk reduction strategies in poor-resource, high risk settings in relation to increased access to antiretroviral treatment (ART) in sub-Saharan Africa Aims: The overall aim was to explore male sexual risk behaviours and sexual risk reduction strategies in urban resource-poor settings in sub-Saharan Africa with implications for sexually transmitted HIV and prevention strategies. Methods: In Sub-study 1 (Papers I III), twenty in-depth, open-ended interviews with South African men who had multiple and concurrent sexual partners were conducted. Sub-study 2 (Paper IV), twenty in-depth interviews were undertaken with male patients. A Thematic Question Guide with open-ended questions was used for the interviews. Sub-studies 1 and 2, a latent content analysis was used to explore the characteristics and dynamics of social and sexual relationships as well as alcohol as facilitating factors for high risk sexual behaviours (Papers I III), and sexual risk reduction strategies among men on ART (Paper IV). Sub-study 3 (paper V) was a cross-sectional study, where 515 consecutive adult male and female patients on ART were interviewed about their risk behaviours. Interviewers used structured questionnaires and SPSS for Windows (version 17.0) was used for statistical analysis. Bivariate and multivariate logistic regression models were performed to assess the association between explanatory variables and the outcomes of consistent condom use and a dichotomized number of sexual partners in the previous six months Findings: In Paper I, a high number of concurrent female sexual partners, geographic mobility and high levels of unprotected sex were common. Male core groups provided mutual economic and social support for the pursuit and maintenance of these networks. Reasons for large concurrent sexual networks (Paper II) were the perception that women were too empowered, could not be trusted, and men had a lack of control over them. Biological determinism further reinforced strong, negative perceptions of women and female sexuality, which helped polarize men s interpretation of gender constructions. A latent association between alcohol and the formation of casual sexual partnerships characterized by exchange, where the potential pathways by which alcohol use and transactional sex are linked (Paper III). Paper IV showed experience of prolonged and severe illness prior to the initiation of ART. Fear of symptom relapse was the main trigger for sexual behaviour change. Partner reduction was reported as a first option for behaviour change and condom use was perceived as more difficult as it had to be negotiated with female partners. In Paper V, almost one third of patients reported inconsistent condom use, indicating frequent unsafe sexual events. Male patients were significantly more likely to use condoms compared to females (82% versus 65%). Longer time on ART was significantly associated with consistent condom use. Multiple sexual partners were more common among married men (adjusted OR 4.38 95% CI 0.82 10.51) compared to married women. Conclusions: There are problematic gender dynamics that clearly affect HIV prevention efforts in urban resource-poor settings. Interventions targeting men at high risk of HIV need to challenge current societal norms of masculinity to help promote individual sexual riskreduction strategies. ART needs to be accompanied by other preventive interventions for increased community effectiveness to reduce the risk of an increasing number of new HIV infections among sero-discordant couples and others. This is important for the donor community and policy makers, who are the major providers of programme support within weak health systems

Boolean complexes for Ferrers graphs

In this paper we provide an explicit formula for calculating the boolean number of a Ferrers graph. By previous work of the last two authors, this determines the homotopy type of the boolean complex of the graph. Specializing to staircase shapes, we show that the boolean numbers of the associated Ferrers graphs are the Genocchi numbers of the second kind, and obtain a relation between the Legendre-Stirling numbers and the Genocchi numbers of the second kind. In another application, we compute the boolean number of a complete bipartite graph, corresponding to a rectangular Ferrers shape, which is expressed in terms of the Stirling numbers of the second kind. Finally, we analyze the complexity of calculating the boolean number of a Ferrers graph using these results and show that it is a significant improvement over calculating by edge recursion.Comment: final version, to appear in the The Australasian Journal of Combinatoric

The construction of an idealised urban masculinity among men with concurrent sexual partners in a South African township

Background : The perspectives of heterosexual males who have large sexual networks comprising concurrent sexual partners and who engage in high-risk sexual behaviours are scarcely documented. Yet these perspectives are crucial to understanding the high HIV prevalence in South Africa where domestic violence, sexual assault and rape are alarmingly high, suggesting problematic gender dynamics. Objective : To explore the construction of masculinities and men's perceptions of women and their sexual relationships, among men with large sexual networks and concurrent partners. Design : This qualitative study was conducted in conjunction with a larger quantitative survey among men at high risk of HIV, using respondent-driven sampling to recruit participants, where long referral chains allowed us to reach far into social networks. Twenty in-depth, open-ended interviews with South African men who had multiple and concurrent sexual partners were conducted. A latent content analysis was used to explore the characteristics and dynamics of social and sexual relationships. Results : We found dominant masculine ideals characterised by overt economic power and multiple sexual partners. Reasons for large concurrent sexual networks were the perception that women were too empowered, could not be trusted, and lack of control over women. Existing masculine norms encourage concurrent sexual networks, ignoring the high risk of HIV transmission. Biological explanations and determinism further reinforced strong and negative perceptions of women and female sexuality, which helped polarise men's interpretation of gender constructions. Conclusions : Our results highlight the need to address sexuality and gender dynamics among men in growing, informal urban areas where HIV prevalence is strikingly high. Traditional structures that could work as focal entry points should be explored for effective HIV prevention aimed at normative change among hard-to-reach men in high-risk urban and largely informal contexts

ABO blood group does not impact incidence or outcomes of surgery for acute type A aortic dissection

Objectives. To evaluate the distribution and impact of ABO blood groups on postoperative outcomes in patients undergoing surgery for acute type A aortic dissection (ATAAD). Design. A total of 1144 surgical ATAAD patients from eight Nordic centres constituting the Nordic consortium for acute type A aortic dissection (NORCAAD) were analysed. Blood group O patients were compared to non-O subjects. The relative frequency of blood groups was assessed with t-distribution, modified for weighted proportions. Multivariable logistic regression was performed to identify independent predictors of 30-day mortality. Cox regression analyses were performed for assessing independent predictors of late mortality. Results. There was no significant difference in the proportions of blood group O between the study populations in the NORCAAD registry and the background population (40.6 (95% CI 37.7–43.4)% vs 39.0 (95% CI 39.0–39.0)%). ABO blood group was not associated with any significant change in risk of 30-day or late mortality, with the exception of blood group A being an independent predictor of late mortality. Prevalence of postoperative complications was similar between the ABO blood groups. Conclusions. In this large cohort of Nordic ATAAD patients, there were no associations between ABO blood group and surgical incidence or outcomes, including postoperative complications and survival

Corticotroph Aggressive Pituitary Tumors and Carcinomas Frequently Harbor ATRX Mutations

Context: Aggressive pituitary tumors (APTs) are characterized by unusually rapid growth and lack of response to standard treatment. About 1% to 2% develop metastases being classified as pituitary carcinomas (PCs). For unknown reasons, the corticotroph tumors are overrepresented among APTs and PCs. Mutations in the alpha thalassemia/mental retardation syndrome X-linked (ATRX) gene, regulating chromatin remodeling and telomere maintenance, have been implicated in the development of several cancer types, including neuroendocrine tumors. Objective: To study ATRX protein expression and mutational status of the ATRX gene in APTs and PCs. Design: We investigated ATRX protein expression by using immunohistochemistry in 30 APTs and 18 PCs, mostly of Pit-1 and T-Pit cell lineage. In tumors lacking ATRX immunolabeling, mutational status of the ATRX gene was explored. Results: Nine of the 48 tumors (19%) demonstrated lack of ATRX immunolabelling with a higher proportion in patients with PCs (5/18; 28%) than in those with APTs (4/30;13%). Lack of ATRX was most common in the corticotroph tumors, 7/22 (32%), versus tumors of the Pit-1 lineage, 2/24 (8%). Loss-of-function ATRX mutations were found in all 9 ATRX immunonegative cases: nonsense mutations (n = 4), frameshift deletions (n = 4), and large deletions affecting 22-28 of the 36 exons (n = 3). More than 1 ATRX gene defect was identified in 2 PCs. Conclusion: ATRX mutations occur in a subset of APTs and are more common in corticotroph tumors. The findings provide a rationale for performing ATRX immunohistochemistry to identify patients at risk of developing aggressive and potentially metastatic pituitary tumors.Peer reviewe

Framtagning av produktionslayout och produktutveckling för tillverkning av hängskenor till hyllsystem

Med de premisser att det endast är priset som avgör materialvalet i plåten till väggskenorna såverkar inte höghållfast plåt vara något konkurrenskraftigt alternativ till det befintliga ochmjukare stålet som används i väggskenorna i den befintliga utrustningen.Förslaget på en layout av produktionsutrustning för tillverkning av hyllskenor är en komplett ocheffektiv rullformningslinje som tillverkar väggskenor, hålade U-profiler, som sedan är klara förlackering. Förslaget på produktionslayout innebär utrustningsmässigt ett flöde frånutgångsmaterialet, en haspel för plåtband, en slinga går till inledare, stansning av hålbild,rullformningsdel, riktverktyg och slutligen en sax som kan klippa väggskenorna till önskadlängd. Detta skulle innebära en förbättring i form av en mer resurssnål tillverkning (lean) för SalsAB. Sals skulle då i stället för som med dagens befintliga system som bygger på inköp avtillverkade U-profiler då på ett kontrollerat och mer effektivt sätt själva kunna styra och utförahela produktionen av hyllskenor. Produktionen skulle då ske genom att tillverka väggskenornahelt på egen hand från hasplad plåt. Produktionen kan då utföras mot kundorder, ”just in time”,och därmed undkomma behovet av någon lagerföring av obearbetade profiler vilket annars krävsmed de hittills partivis inköpta U-profiler samt att inte vara längre vara beroende av fungerandeleveranser av dessa

Framtagning av produktionslayout och produktutveckling för tillverkning av hängskenor till hyllsystem

Med de premisser att det endast är priset som avgör materialvalet i plåten till väggskenorna såverkar inte höghållfast plåt vara något konkurrenskraftigt alternativ till det befintliga ochmjukare stålet som används i väggskenorna i den befintliga utrustningen.Förslaget på en layout av produktionsutrustning för tillverkning av hyllskenor är en komplett ocheffektiv rullformningslinje som tillverkar väggskenor, hålade U-profiler, som sedan är klara förlackering. Förslaget på produktionslayout innebär utrustningsmässigt ett flöde frånutgångsmaterialet, en haspel för plåtband, en slinga går till inledare, stansning av hålbild,rullformningsdel, riktverktyg och slutligen en sax som kan klippa väggskenorna till önskadlängd. Detta skulle innebära en förbättring i form av en mer resurssnål tillverkning (lean) för SalsAB. Sals skulle då i stället för som med dagens befintliga system som bygger på inköp avtillverkade U-profiler då på ett kontrollerat och mer effektivt sätt själva kunna styra och utförahela produktionen av hyllskenor. Produktionen skulle då ske genom att tillverka väggskenornahelt på egen hand från hasplad plåt. Produktionen kan då utföras mot kundorder, ”just in time”,och därmed undkomma behovet av någon lagerföring av obearbetade profiler vilket annars krävsmed de hittills partivis inköpta U-profiler samt att inte vara längre vara beroende av fungerandeleveranser av dessa