Body habitus changes, metabolic abnormalities, and subclinical coronary atherosclerosis associated with long-term antiretroviral therapy

The public health significance of this work reflects the HIV/AIDS epidemic and growing concerns of long-term consequences of antiretroviral therapy. The advent of highly active antiretroviral therapy (HAART) has greatly improved survival among those with HIV-infection. As a corollary, clinicians and researchers face a range of long-term complications previously of little importance to HIV-infected patients. HIV-associated lipodystrophy syndrome (HIV-LS) was first described in 1998 and involves a constellation of metabolic and morphologic abnormalities. Whereas AIDS wasting syndrome has been associated with immunosuppression and high viral burden, HIV-LS has been documented with immunocompetence and suppressed viral concentration. Participants of the local site of the Multicenter AIDS Cohort Study (MACS) consented to photography of their lipodystrophic body habitus changes during routine clinic appointments. The compilation of these photographs was used to develop a manual for clinicians at all four of the MACS sites in order to accurately document the syndrome, and permitted initial classification of HIV-LS into two phenotypes. A third phenotype was identified following a preliminary observation of lipoaccumulation extending bilaterally and symmetrically from the breasts laterally into the axilla. Additional cases were subsequently identified within the MACS; all subjects had pre-existing lipoaccumulation of at least one other anatomical site. It was speculated as to whether this represented a previously unrecognized evolution of HIV-LS. Our next project involved studying the health related quality of life (HRQL) of men with HIV-LS. We found HIV-LS does not negatively affect HRQL or exacerbate depressive symptoms above and beyond the diagnosis of HIV-infection. The metabolic abnormalities of HIV-LS include insulin resistance and dyslipidemia, both of which are considered pro-atherogenic risks. The final segment of this project involved detecting coronary artery calcification via electron beam computed tomography among HIV-infected men treated with HAART. In this male population with well controlled HIV-infection, chronic use of HAART did not impact the progression of subclinical coronary atherosclerosis. In contrast, traditional atherosclerosis risk factors of smoking and advancing age were predictive of coronary atherosclerosis. HIV-infection requires life-long combination treatment. Clinicians, researchers and patients recognize dyslipidemia, peripheral lipoatrophy and central lipohypertrophy as significant consequences of this combination therapy, and hope that concerns regarding increasing cardiac risk are not warranted

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men

Objective: The aim of this article is to determine whether HIV-infected (HIV+) men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared with HIV-uninfected (HIV∗) controls. Design: Prospective observational study. Setting: Multicenter study in four US academic research centers: University of Pittsburgh, Johns Hopkins University, University of California Los Angeles, and Northwestern University. Participants: Eight hundred and twenty-five men (541 HIV+and 284 HIV∗) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study who underwent serial cardiac computed tomography (CT) imaging during a mean follow-up of 5 years (range, 2-8 years). Main outcome measures: Incidence and progression of CAC assessed by cardiac CT. Results: During follow-up, 21% of HIV+ men developed incident CAC compared with 16% of HIV∗ men. This association persisted after adjustment for traditional and HIVassociated risk factors: hazard ratio 1.64 (1.13-3.14). However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy. Conclusion: In this large study of HIV+ and HIV∗ men who underwent serial cardiac CT scan imaging, HIV+ men were at significantly higher risk for development of CAC: hazard ratio 1.64 (1.13-3.14). In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV+ men

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men

ObjectiveThe aim of this article is to determine whether HIV-infected (HIV+) men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared with HIV-uninfected (HIV-) controls.DesignProspective observational study.SettingMulticenter study in four US academic research centers: University of Pittsburgh, Johns Hopkins University, University of California Los Angeles, and Northwestern University.ParticipantsEight hundred and twenty-five men (541 HIV+ and 284 HIV-) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study who underwent serial cardiac computed tomography (CT) imaging during a mean follow-up of 5 years (range, 2-8 years).Main outcome measuresIncidence and progression of CAC assessed by cardiac CT.ResultsDuring follow-up, 21% of HIV+ men developed incident CAC compared with 16% of HIV- men. This association persisted after adjustment for traditional and HIV-associated risk factors: hazard ratio 1.64 (1.13-3.14). However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy.ConclusionIn this large study of HIV+ and HIV- men who underwent serial cardiac CT scan imaging, HIV+ men were at significantly higher risk for development of CAC: hazard ratio 1.64 (1.13-3.14). In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV+ men

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men

Objective: The aim of this article is to determine whether HIV-infected (HIVþ) men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared with HIV-uninfected (HIVÀ) controls. Design: Prospective observational study. Setting: Multicenter study in four US academic research centers: University of Pittsburgh, Johns Hopkins University, University of California Los Angeles, and Northwestern University. Participants: Eight hundred and twenty-five men (541 HIVþ and 284 HIVÀ) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study who underwent serial cardiac computed tomography (CT) imaging during a mean follow-up of 5 years (range, 2-8 years). Main outcome measures: Incidence and progression of CAC assessed by cardiac CT. Results: During follow-up, 21% of HIVþ men developed incident CAC compared with 16% of HIVÀ men. This association persisted after adjustment for traditional and HIVassociated risk factors: hazard ratio 1.64 (1.13-3.14). However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy. Conclusion: In this large study of HIVþ and HIVÀ men who underwent serial cardiac CT scan imaging, HIVþ men were at significantly higher risk for development of CAC: hazard ratio 1.64 (1.13-3.14). In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIVþ men

Effects of intermittent punishment on self-injurious behavior: an evaluation of schedule thinning.

Although the use of punishment often raises ethical issues, such procedures may be needed when the reinforcers that maintain behavior cannot be identified or controlled, or when competing reinforcers cannot be found. Results of several studies on the effects of intermittent schedules of punishment suggest that therapists must use fairly rich schedules of punishment to suppress problem behavior. However, residential caretakers, teachers, and parents often have difficulty implementing programs that require constant monitoring of the client's behavior. In this study, we examined the feasibility of gradually thinning the delivery of punishment from a continuous schedule to an intermittent schedule during the course of treatment for self-injurious behavior (SIB). Results of functional analyses for 5 individuals who had been diagnosed with profound mental retardation indicated that their SIB was not maintained by social consequences. Treatment with continuous schedules of time-out (for 1 participant) or contingent restraint (for the other 4 participants) produced substantial reductions in SIB. When they were exposed to intermittent schedules of punishment (fixed-interval [FI] 120 s or FI 300 s), SIB for all but 1 of the participants increased to levels similar to those observed during baseline. For these 4 participants, the schedule of punishment was gradually thinned from continuous to FI 120 s or FI 300 s. For 2 participants, SIB remained low across the schedule changes, demonstrating the utility of thinning from continuous to intermittent schedules of punishment. Results for the other 2 participants showed that intermittent punishment was ineffective, despite repeated attempts to thin the schedule

Le symbolique et le social

La catégorie du symbolique joue un rôle central dans la pensée de Pierre Bourdieu. Elle a pourtant a été assez peu théorisée en tant que telle, alors que d’autres notions clés, comme celles d’habitus ou de champ, ont fait l’objet de reprises méthodiques et de commentaires minutieux. C’est à combler cette lacune que l’on s’emploie dans le présent ouvrage, en faisant valoir que le symbolique concentre la démarche du sociologue dans ce qu’elle a de plus singulier. Sociologues, philosophes, théoriciens du langage, spécialistes de la littérature ou des médias, les auteurs réunis ici procèdent à cette réévaluation sous trois aspects, qui correspondent à autant de champs de réflexion : anthropologie, culture et politique. Au-delà, c’est du rayonnement international de l’œuvre de Pierre Bourdieu qu’il s’agit de témoigner, et aussi de la diversité des objets qu’une même discipline de pensée continue de prendre en compte : de la gastronomie à la photographie, des littératures périphériques à l’art d’avant-garde, des politiques de contrôle social aux pratiques journalistiques. Le présent volume constitue une nouvelle édition des Actes du colloque qui s’est tenu au Centre Culturel International de Cerisy du 12 au 19 juillet 2001 avec la participation du sociologue, dont l’intervention est recueillie au sommaire. L’introduction générale en a été mise à jour afin de faire place aux développements apportés par celui-ci au concept de symbolique dans ses cours au Collège de France sur la genèse de l’État, publiés entre-temps. L’épilogue de l’ouvrage est assuré par l’écrivain Annie Ernaux