TAKING THE MIDDLE GROUND IN INTERACTIONIST RELATIONSHIPS IN QUEENSLAND TECHNICAL AND FURTHER EDUCATION (TAFE), AUSTRALIA

This study explores the support and services utilised by adult students with dyslexia in five Australian TAFE Colleges In this study, adult students with dyslexia were completing Certificate III and above programs in Technical and Further Education (TAFE) Colleges. In exploring the support provided in TAFE, Disability Officers were utilised in the provision of support and servicing adult students. As identified that Disability Officers, not only offered services to adult students with dyslexia, they became their critical friends and aided in social settings external to the TAFE Colleges. The methodology was an embedded case study, which utilised semi-structured interview questions, in 28 participants. The theories used were Lipsky’s (1983, 2010) Street-Level Bureaucracy and Fine and Sirin’s (2007) Hyphenated-Self. A foundational method as developed in this study, known as the Relational: Hyphenated-Self to explain the inclusion and exclusion perceived by adult students with dyslexia as they were progressing in TAFE.  Article visualizations

WHAT IS THE EFFECT OF DYSLEXIA AND MEARES-IRLEN SYNDROME IN ADULT VOCATIONAL STUDENTS?

This exploration found that six of the 22 adult students with dyslexia presented with Meares Irlen Syndrome (MIS). This comorbidity was diagnosed in 27% of participants. Several adult students have no diagnosis of MIS, yet had symptoms of this condition. There was evidence that a further ten participants exhibited symptoms; some had a reaction to light when using computers; others had migraines when reading books or doing other visual work, and others had difficulty concentrating on written work for more than one hour.  It is a quandary for educators who support adult students with dyslexia, in preparing lesson plans for inclusion when there is limited research in the field of education and MIS. In this social constructionist study, 22 diagnosed adult students with dyslexia were interviewed within five Queensland Technical and Further Education (TAFE) Institutes/Colleges, regarding their reading and literacy abilities.  Article visualizations

THE DISCRETIONARY PRACTICES IN TAFE: A CASE OF DISABILITY OFFICERS AND ADULT STUDENTS WITH DYSLEXIA

Internationally, there are gaps in our understanding of the role of Disability Service Officers (DSOs) in education systems. Furthermore, there is limited research on the support that is provided by DSOs in Australian Technical and Further Education (TAFE) colleges. This study found that DSOs became autonomous advocates who cared for students with dyslexia and learning disabilities (LDs) by operating beyond the TAFE position statements to provide much-needed student support. In effect, TAFE DSOs used the discretionary practice to become Street-Level Advocates by using both autonomy and advocacy to give vital support to adult students with dyslexia and learning disabilities. Dyslexia has a significant impact on learning and affects approximately one in ten people. It is essential that educational support is provided for people with dyslexia since those with support can learn strategies to overcome barriers in education. TAFE is undergoing organisational change, which influences the role description and role of the DSOs in these colleges. This qualitative study used semi-structured, one-on-one interview questions to sample both students with dyslexia and DSOs within five TAFEs in Queensland.  Article visualizations

WHEN DISABILITY SERVICE OFFICERS BECOME STREET-LEVEL ADVOCATES IN QUEENSLAND TECHNICAL AND FURTHER EDUCATION CONTEXTS THROUGH ARISTOTLE’S NICOMACHEAN ETHICS

Aristotle, The Grand Master of Philosophy and Literature, developed many theories relating to inequality which remain relevant in this current millennium. This qualitative study examined the role of Disability Service Officers (DSOs) in Technical and Further Education (TAFE) and explored their approach to students with dyslexia using Aristotelian theory. This case study used semi-structured interviews in five TAFE Colleges within Australia. A foundational theory of Street-Level Advocates emerged from the DSOs interactions with adult students with dyslexia. Disability Service Officers interactions aligned with Aristotle's philosophy of Nicomachean Ethics; and knowledge, thinking, and ethics of humanity, whilst practicing good deeds. Aristotle’s theory plays an integral part of this research, as he provides knowledge of good deeds, not unlike DSOs in TAFE.  Article visualizations

In vitro activity of seven hospital biocides against Mycobacterium abscessus: Implications for patients with cystic fibrosis

Background: Mycobacterium abscessus pulmonary infection has recently emerged as a significant pathogen in patients with cystic fibrosis (CF) and is associated with significant morbidity and accelerated pulmonary decline. There is a paucity of data describing the activity of hospital biocides against this organism. Methods: M. abscessus isolates (n = 13) were recovered from CF and non-CF respiratory specimens. Seven commonly employed hospital biocides with generic ingredients as follows: acetone, propan-2-ol, diethylene glycol, 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one, chlorine dioxide, 4% chlorhexidine, alcohol, and disodium carbonate, compound with hydrogen peroxide, 10% sodium hypochlorite were assayed for their biocidal activity against M. abscessus. Fresh cultures of M. abscessus were exposed to biocide in liquid medium as per manufacturers' instruction and were immediately plated following the completion of the contact period. The mean concentration of M. abscessus plated was 9.82 × 106 colony-forming units (range: 1.63 × 105–1.12 × 108). In addition, the remaining bacteria/biocide solution was enriched nonselectively in Mueller Hinton broth (37°C/1 week) and then plated. Results: All M. abscessus isolates survived in alkyl dimethyl benzyl ammonium chloride, 5-chloro-2-methyl-2H-isothiazol-3-one (EC No. 247-500-7) and 2-methyl-2H-isothiazol-3-one, 4% Chlorhexidine™, O-phenylphenol and Sodium Lauryl Sulfate™ and disodium carbonate, compound with hydrogen peroxide. One out of 13 M. abscessus cultures was killed by Chlorine Dioxide™ and one by Sodium Dichloroisocyanurate™, representing a 5-log kill. Two isolates were killed by Alcohol™ again representing a 5 log kill. Following enrichment, O-phenylphenol and Sodium Lauryl Sulfate™ showed the greatest biocidal activity with 11/13 isolates, whereas 2/13 cultures were killed by sodium dichloroisocyanurate™. All other biocide/culture combinations yielded growth. Conclusion: These data indicate that M. abscessus may persist after exposure to several common hospital biocides. Further work is urgently needed to define unequivocal biocide contact treatments to prevent cross-infection with this mycobacterial species in this patient population and thus ensure effective infection control and prevention

Oral bisphosphonate use and all-cause mortality in patients with moderate-severe (grade 3B-5D) chronic kidney disease: a population-based cohort study

Oral bisphosphonates (oBPs) have been associated with reduced fractures and mortality. However, their risks and benefits are unclear in patients with moderate–severe CKD. This study examined the association between oBPs and all-cause mortality in G3B-5D CKD. This is a population-based cohort study including all subjects with an estimated glomerular filtration rate (eGFR) &lt;45/mL/min/1.73 m 2 (G3B: eGFR &lt;45/mL/min/1.73 m 2 G4: eGFR 15–29/mL/min/1.73 m 2 G5: eGFR &lt;15/mL/min/1.73 m 2 G5D: hemodialysis) aged 40+ years from the UK Clinical Practice Research Datalink (CPRD) and the Catalan Information System for Research in Primary Care (SIDIAP). Previous and current users of other anti-osteoporosis drugs were excluded. oBP use was modeled as a time-varying exposure to avoid immortal time bias. Treatment episodes in oBP users were created by concatenating prescriptions until patients switched or stopped therapy or were censored or died. A washout period of 180 days was added to (date of last prescription +180 days). Propensity scores (PSs) were calculated using prespecified predictors of mortality including age, gender, baseline eGFR, socioeconomic status, comorbidities, previous fracture, co-medications, and number of hospital admissions in the previous year. Cox models were used for PS adjustment before and after PS trimming (the first and last quintiles). In the CPRD, of 19,351 oBP users and 210,954 non-oBP users, 5234 (27%) and 85,105 (40%) deaths were recorded over 45,690 and 915,867 person-years of follow-up, respectively. oBP users had 8% lower mortality risk compared to non-oBP users (hazard ratio [HR] 0.92; 95% CI, 0.89 to 0.95). Following PS trimming, this became nonsignificant (HR 0.98; 95% CI, 0.94 to 1.04). In the SIDIAP, of 4146 oBP users and 86,127 non-oBP users, 1330 (32%) and 36,513 (42%) died, respectively. oBPs were not associated with mortality in PS adjustment and trimming (HR 1.04; 95% CI, 0.99 to 1.1 and HR 0.95; 95% CI, 0.89 to 1.01). In this observational, patient-based cohort study, oBPs were not associated with increased mortality among patients with moderate–severe CKD. However, further studies are needed on other effects of oBPs in CKD patients.</p

Early intervention with 3BNC117 and romidepsin at antiretroviral treatment initiation in people with HIV-1: a phase 1b/2a, randomized trial

Attempts to reduce the human immunodeficiency virus type 1 (HIV-1) reservoir and induce antiretroviral therapy (ART)-free virologic control have largely been unsuccessful. In this phase 1b/2a, open-label, randomized controlled trial using a four-group factorial design, we investigated whether early intervention in newly diagnosed people with HIV-1 with a monoclonal anti-HIV-1 antibody with a CD4-binding site, 3BNC117, followed by a histone deacetylase inhibitor, romidepsin, shortly after ART initiation altered the course of HIV-1 infection (NCT03041012). The trial was undertaken in five hospitals in Denmark and two hospitals in the United Kingdom. The coprimary endpoints were analysis of initial virus decay kinetics and changes in the frequency of CD4+ T cells containing intact HIV-1 provirus from baseline to day 365. Secondary endpoints included changes in the frequency of infected CD4+ T cells and virus-specific CD8+ T cell immunity from baseline to day 365, pre-ART plasma HIV-1 3BNC117 sensitivity, safety and tolerability, and time to loss of virologic control during a 12-week analytical ART interruption that started at day 400. In 55 newly diagnosed people (5 females and 50 males) with HIV-1 who received random allocation treatment, we found that early 3BNC117 treatment with or without romidepsin enhanced plasma HIV-1 RNA decay rates compared to ART only. Furthermore, 3BNC117 treatment accelerated clearance of infected cells compared to ART only. All groups had significant reductions in the frequency of CD4+ T cells containing intact HIV-1 provirus. At day 365, early 3BNC117 + romidepsin was associated with enhanced HIV-1 Gag-specific CD8+ T cell immunity compared to ART only. The observed virological and immunological effects of 3BNC117 were most pronounced in individuals whose pre-ART plasma HIV-1 envelope sequences were antibody sensitive. The results were not disaggregated by sex. Adverse events were mild to moderate and similar between the groups. During a 12-week analytical ART interruption among 20 participants, 3BNC117-treated individuals harboring sensitive viruses were significantly more likely to maintain ART-free virologic control than other participants. We conclude that 3BNC117 at ART initiation enhanced elimination of plasma viruses and infected cells, enhanced HIV-1-specific CD8+ immunity and was associated with sustained ART-free virologic control among persons with 3BNC117-sensitive virus. These findings strongly support interventions administered at the time of ART initiation as a strategy to limit long-term HIV-1 persistence

Early intervention with 3BNC117 and romidepsin at antiretroviral treatment initiation in people with HIV-1: a phase 1b/2a, randomized trial

Attempts to reduce the human immunodeficiency virus type 1 (HIV-1) reservoir and induce antiretroviral therapy (ART)-free virologic control have largely been unsuccessful. In this phase 1b/2a, open-label, randomized controlled trial using a four-group factorial design, we investigated whether early intervention in newly diagnosed people with HIV-1 with a monoclonal anti-HIV-1 antibody with a CD4-binding site, 3BNC117, followed by a histone deacetylase inhibitor, romidepsin, shortly after ART initiation altered the course of HIV-1 infection (NCT03041012). The trial was undertaken in five hospitals in Denmark and two hospitals in the United Kingdom. The coprimary endpoints were analysis of initial virus decay kinetics and changes in the frequency of CD4+ T cells containing intact HIV-1 provirus from baseline to day 365. Secondary endpoints included changes in the frequency of infected CD4+ T cells and virus-specific CD8+ T cell immunity from baseline to day 365, pre-ART plasma HIV-1 3BNC117 sensitivity, safety and tolerability, and time to loss of virologic control during a 12-week analytical ART interruption that started at day 400. In 55 newly diagnosed people (5 females and 50 males) with HIV-1 who received random allocation treatment, we found that early 3BNC117 treatment with or without romidepsin enhanced plasma HIV-1 RNA decay rates compared to ART only. Furthermore, 3BNC117 treatment accelerated clearance of infected cells compared to ART only. All groups had significant reductions in the frequency of CD4+ T cells containing intact HIV-1 provirus. At day 365, early 3BNC117 + romidepsin was associated with enhanced HIV-1 Gag-specific CD8+ T cell immunity compared to ART only. The observed virological and immunological effects of 3BNC117 were most pronounced in individuals whose pre-ART plasma HIV-1 envelope sequences were antibody sensitive. The results were not disaggregated by sex. Adverse events were mild to moderate and similar between the groups. During a 12-week analytical ART interruption among 20 participants, 3BNC117-treated individuals harboring sensitive viruses were significantly more likely to maintain ART-free virologic control than other participants. We conclude that 3BNC117 at ART initiation enhanced elimination of plasma viruses and infected cells, enhanced HIV-1-specific CD8+ immunity and was associated with sustained ART-free virologic control among persons with 3BNC117-sensitive virus. These findings strongly support interventions administered at the time of ART initiation as a strategy to limit long-term HIV-1 persistence